2016_0817 (3) CFiECK ONE:
IRItIGATION DOMESTIC FIRELINE
BACKFLOW 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
T3e bac1�low prevmtion assembly detailed below has beea tesud aad maintained as required by TNRCC
regulations and is ceitified to be operating withia acceptable parameters.
/ TYPE OF ASSEMBLY
C� Reduad Pressurc Priaciple C Pressure Vacu�Brealcer
❑ Double Chtck Valve a Atmosphere Vacuum Breaker
Maaufactvrer V�'01�� Siu � �4`�
Modei Ivumber �'1��/�i��� Located At � Ci�e r �n. � C,��i1ec`
Serial Number
ya�7� o� �►��,. � �.. �����,,,�
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V ACUUM BREAI�R
Doubk Check V alve Assembly
ist Check �nd Checl: 'ef Valve Air Inlet Checic Valve
Initial Tat DC-Closed Closed Tighc ;�at Opeaed at csid
�_1+�)(� Ti Lcaked ❑ Cs •�Psid osid
RP�sid 7,�'y
PGl�a � Leal:ai D Did aot Open ❑ Lcal:ed �
RePaus
and
Maurials
Used
Tesc ARcr DC-Closed Closed Tighc o Opeaed ac Opea�d ac _nsid
Repair Tight o nsid nsid
R.P sid
The above is catifiod to be true.
FirmName Allied FlowSpecialists, Inc. CetifiedTesta Christopher L. Coffman
I FitmAddressPO Box 1150 Midlothian,TX 76065 Cat Teste:No. BP0016261 D� 8/17/16
; Gauge # 05141063
' Date last accuracy tested 7-21-16
' White- Customer's Copy Yellow - City Copy Pink-Tester's Copy