2015_1023 IRRIGATION DOMESTIC FIRELINE X
The following form inust be eompleted for eac]1 assembly tested. :1 signed and dated original
must be submitted to the public water supplier for recordkeeping purposes:
BACKFLOW PREVENTION,�SSEMBLY`TE�T'Al�`D;1��I�'T'ENANCE REPORT
NAME OF P�VS: CITY OF COPPELL PW'S I.D. #0�70040
(Customer)
i�AILWG ADDRESS: 253 Club Circle Dr CoRpell TX 75019
C01v'TACT PERSO�I,!PHONE: Denise 214-930-0933
LOCATI4N QF SERVICE: '
The backflow prevention assembly detailed belo��-has een tested and maintzined as required by
commission regulations and is ceirtified to be operating���ithin eicceprable�aran�eters.
"�'YP�OF AS5�IV�BI�Y
Reduced Pressure Principle Reduced Pz•e�sure Piinciple-Detector
X Double Cl�eck Valve Double Check-Detector
PressureVacuumBreaker Spi1l=Resistant Pressure Vacuum Breaker
Mamifacturer_ �Y�ntl� Nlodel Number �(9pp� Size �"
Located nt Q Seri��l NumF�er �3�11�
Is th�assembly installed i accordance��ith manufacturer reconunendations and%or local codes'? �Q
Reduced Presslrrc Princi�le Assembh� Pa-essure Vacuum Breaker
Double Clteck Valve Assembly
Relief Valve Air Inlet Check Valve
1 st Check ?nd Check �
P�� Held at o`Z.�1 sid Helc!�t
p 2.0 ps� Opened at_ O��ened at Hcld 1t
Initi�l Test Closed Tight�/ Closed TiQl�t psid psi�l ��i�{
Leaked Leaked Did not open Did not open Leaked
Repairs/
Materials
Used
Hcld at psid Hcld at psid
Test After Opcncd at Opcued at Held at
Repair ClosedTight : ClosedTight ps�� psid psid
Test gauge used: Make/Model Anollo 40-200-t�C5u SN: 04142867
Date Tested for Accuracy: 5/4/2015
Remarks:
The above is certified to be n•ue ae the time of testing.
Finn Name Diamondback Fire Protection Finn Address PO Box 2507, Waxahachie TX 75168
Certitied Tester(rr;nt�oe Standridge Certitied Tcste�-(signatur�,
E=irn1 Phone# (214)444-3194 Cert.Testcl•��o. BP0015823 Date 10/23/2015
�TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS
'�`*USE�NLY MANUFACTURFR'S REPLACEMENT'PARTS
White-City Copy Yello�v-Customer Copy Pink-Tester's Copy