2015_1023 IRRIGATION DOMESTIC FIRELINE X
The followin� for�n must be completed for each assemblv tested. A si�ned and dated ori�inal
rnust be submitted to the public��ater supplier for recordkeeping purposes
BACKFLOW PRE�'ENTIOI�A�SEMBL�'TES'i'!�NE3 i1�I�TTEN�NC'E REPORT
NAME OF PWS: CITY OF COPFELL PWS I.D. #0�70040
(Customer)
MAIL[NG ADDRESS: 2�-3 Club Circle Dr Co�t�ell TX 75019
COIvtTACT PERSON!PHONE: Denise 214930-0933
LOCATION OF SERVICE: �5! L'6,orE+.
The backflow prevention assembly detailed belo�;�has been tested and m�i�itained as required by
commission re�ilations and is certitied to be operating«�itllin acceptable paramctcrs.
'TYPE OF ASSEPl��BLS'
: Reduced Pressure Principle Reducecf Pressure Principle-Detector
X Double Check Valve Double C'heck-Detector
PressureVacuumBreaker Spi1l=Resistant Pressure Vacuum Breaker
Manufacturer_��� NTodet Number 2DC�b g Size /"
Located At �-1 r _o. �erial Nwnber (�'q 31
Is the assembly installed in accardance with mamifacturer reco�nmendations and%or local codes`? �
Reduced Pressurc Princi�le Assembl�r Pressure�'acuum Breaker
Double Check Valve Assembly
1 st Check � Relief Vah�e Air Inlet Check Vaive
nd Chcck
�o� Held at�.d psid He(d c1t��psid Opened at Open�d at Held at
lnitial TesY Closcd Tight '� Closcd Tighc � psict � psid ��yi�{
Leaked Leaked Did not o�en Did not open Leaked
Repairs/
Materials �
Used
Hcld at psid Hel�l at psid
Test After � �pcued a[ Opened at Held at
Repair ClosedTight ClosedTight . Ps;d psid psid
Test gauye used: Make/Model�jo 40-200-tk5u SN: 04142867
Date Tested for Accuracy: 5/4/2015
Remarks:
The above is certified to be true at the ti�ne of testin�.
Finn Na�ne Diamondbadc Fire Protection Firnl Address PO Box 2507, Waxahaehie TX 75168
Certified Testcr(pi-:��t�oe Standridge Certitied Tcster(si��natur '
Firm Phone# (214)444-3194 Ccrt.Tester;�?o. BP0015823 Uate 10/23/2015
��TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS
�* USE ONLY MAI�JUFACTURER'S REPLACEMENT PARTS
White-City Copy I'ello��s�-C'ustomer Copy Pink-Tester's Copy