2016_0817 C�iECK ONE:
IRRIGATION DOMESTIC � FIRELINE
BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.# Shell Gateway
LOCATION OF SERVICE: 1000 Royal Ln., Coppell, TX 75019
The bac�low preveation asscmbly derailed below has beea tesud and maintain� � � bv 1'NRCC
regulations aad is certified to be operating withia acceptable parameters.
/ TYPE OF ASSEMBLY
a� Reduc�ed Pressure Priaciple C Pressure Vacu�Bieaker
� Double Check Valve ❑ A�aosphere Vacuum Breaker
` , 2 �J ��
Maaufactiaer �dl TT� Siu /�
Modei Ivumber ��9�•� Located At �_C�Ae' o� �i�c�1���_MC.�(
Scrial N�ber TI �°����
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Doubie Check Valve Assembly
lst Check Zad Checl: Relief Valve Air Inlet C6eck Valve
Ini�al Test DGClosed Close�Ti,rht ❑ at Opeaed at osid
� ��-�(�, Tight ❑ Leal:ed sid nsid
RP-O'�Psid (�9 G�
�; ( �;� Did not Open O Leal:ed �
�� �U� ce�q;s� rh�der
aad
Mataials
Used
Test At?�r DG-Closed Closed Tight o Opmed at Opmed at nsid
Rapair Tight o nsid osid
RP sid
The abova is catified to be tnu.
FumName Allied Flow Specialists, inc. Cercified7esta Christopher L. Coffman
jI Fitm Add�sSPo aox 1150►wid�othian,TX 76065 Cert.Testallo. BP0016261 D� 8/17/16
; Gauge # 05141063
!� Date last accuracy tested 7-21-16
�� '
Wtute-Customer s Copy Yellow -City Copy Pink-Tester's Copy
.,�: