2015_1023 IRRIGATION DOMESTIC FIRELINE X
The fo11o4ving for�n must Ue con�pleted foi- ezch asse►nbiv iested. A signed and dat�d ariginal
must be submitted to the pt�blic�uater supplier for recordkeeping ptuposes:
BACKFLOW PREVENTpON ASSEMgL4'TES'I'AND��fl,�d?R''I'L'V�l��CE REPORT
NAME OF PWS: CITY OF COPPELL PWS I.D. #0�70040
(Customer)
MAILING ADDRESS: 253 Club Circle Dr Co�pell TX 75019
CONTACT PERSO�I/PHONE: Denise 214-930-0933
LOCATION OF SERVICE: '
The backflow prevention assembly detailed belo�� s been tested and mai�itained as required by
commission regulations and is certitied to be operating�vithin acceptahle paran�eters.
TYPE OF ASS�NdBL�'
: Reduced Pressure Principle Reducecl Pressure Piinciple-Detector
X Double Check Valve Double C'hecl:-Detector
PressureVacuumBreaker Spi1l=Resistant Pressure Vacuum Breaker
Manufacturer�ry�9 Model Niunber ,,21��,8 Size ��'_
Located E1t C. Serial Number_k$$'O�
Is the assembly instaited in accordance witll manufactiu-er recomme�iciatious and/or local codes?
Reduced Pressurc Princi�Ic Assembl�� Pressure�tacimm Breaker
Double Cl�eck Valve Assembly
Re]ief Valve Air Inlet Check Valve
1 st Check 2nd Check
� Held at �•� psid Held at �.b psid Opcned at___ Opcned at Neld at
Initial Test Closcd Tight✓ Closcd Tight ✓ psid psicl psid
Leaked Leaked Did not o�en Did not open Leaked
Repairs/
Materials i
Used
Hcld at psid Hcl�l at psid
Test After Opcu�d at C)pe»ed at Held at
Repair ClosedTight i ClosedTight psid psid psid
Test gauge used: Make/Model Anollo 40-200-tk5u SN:_ 04142867
Date Tested for Accuracy: 5/4/2015
Retnarks:
The above is certified to be true at the time of testing.
Firnl Name Diamondback Fire Protection Finn Address PO Box 2507, Waxahachie,TX 75168
Certified Tester(pr:�,.t1�oe Standridae Certifed Tester(signatin�e)�'�7��'"�''�.-c
Finn Phone#_(214)444-3194 Cert.Tester N��. BP0015823 _Date 10/23/2015
'�TEST RECORDS MUST BE IfEPT FOR AT LEAST THREE YEARS
*'�USE ONLY MANUFACTURER'S REPLACEMENT PARTS
White-City Copy Yello���-Customer Copy Pink-Tester's Copy