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2016_0817 (4) C�iECH ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT' NAI�OF PWS: CITY OF COPPELL PWS I.D.# Shell Gateway LOCATION OF SERVICE: 1000 Royal Ln., Coppell, TX 75019 The bacL�flow pczvention ass«ably derailed beiow has bem usted aad main�ain� � � bv TNRCC reguladons aad is certified to be operating withia acceptable paramcters. TYPE OF ASSEMBLY C� Reducai Pressure Principle e Pmsure Vacuimm Breaker :�� Dauble Check Valve o A�aosphere Vacuum Breaker � .� Maaufactzacr ��� Siu �y Model Iv�ber ������-7 Located At �ovtAD � 5� Scrial N�ber �7��� � �' ��+���-�/�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BRE1iI�R Double Check v alve Assembly lst Check 2nd Check Relief Valve Air ldet C6eck Valve Iaidal Test DGClosed Closed Ti,�ht Opeaed at Opeaed at nsid ' �_p"�-t(p Ti Leal:ed � nsid nsid RP���Dsid ���s � o �• � aa noc o� ❑ r�;�a o �� � Maurials Used Test ARtr DC-Closed Closed Tight o Opeaed at Opmed at nsid Repair Tight o �sid flsid RP sid T�e above is ca'tifiod to be t�ue. Fi:m Name Allied Flow Specialists, inc. Certified Testes Christopher L. Coffman FirmAdd�SSPO Box 1150 Midlothian,TX 76065 Cat TesterNo. BP0016261 ]�� 8/17/16 ' Gauge # 05141063 ' Date last accuracy tested 7-21-16 White-Customer's Copy Yellow- City Copy Pink-Tester's Copy C�IECK ONE: / a IRRIGATION DOMESTIC FIRELINE �� BACI�I.OW PREVENTION ASSEMBLY TEST AND MAIIV'TENANCE REPORT NAI�OF PWS: CITY OF COPPELL PWS I.D.# Shell Gateway LOCATION OF SERVICE: 1000 Royal Ln., Coppell, TX 75019 The bacl�low prevmrion assembly derailed below has beea tested aad maintained as required by TNRCC reguladons aad is certified W be operating withia acceptable parameters. - 'I'YPE OF ASSEMBLY �C Reduad Pressure Principlq , C Pmsure Vacui�Breaker Double Check Valve�etE�r ❑ Auaosphere Vacuum Breaker `- ' t� Maaufactiaer W��� Siu � Modei Iv�ber ! �I L'I ��D� Locaud At C'e��,�� dq�.l�� . �i� Serial N�ber f� 1 �'� � ��' `�:�1:�ne r►1���t REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUiJM BREAI�R Doubl�Check Valve Assambly lst Check 2nd Check 'ef Valve Air Inlet Check Valve � Inival Test DC-Closed Closed Tight Opeaed at Opmed at �osid �_���(� Ti Q Lealced ❑ osid osid R.P�=psid �.� ��� �;� o Did not Open � Leai:ed � RePairs and Mataials Usod Test Atter DC-Closed Closed Tight o Opeaed at Opmed at nsid Repair Tight ❑ _flsid osid RP sid The above is catified to be true. , Firm Na�e Allied Flow Specialists, Inc. C��'I'� Christopher L. Coffman II, FirmAddressPO Box 1150 Midlothian,TX 76065 C�,TestetNo. BP0016261 ])� 8/17/16 j (�auge # 05141063 ' Date last accuracy tested 7-21-16 White-Customer's Copy Yellow - City Gopy Pink-TesteCs Copy CHECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION A5SEMBLY TES'T AND MAINTENANCE REPORT' NAI�OF PWS: CITY OF COPPELL PWS I.D.# Shell GatewaV LOCATION OF SERVICE: 1000 Royal Ln., Coppell, TX 75019 Ibe bacl�low p:zvmtion assembly detailed below has bem tested and maintain� � nq�� �, �CC regulauons aad is certified to be operating withia acceptable parameters. TYPE OF ASSEMBLY C/ Rcduced Presstae Principle C Pressure Vacuimm Breaker 9� Double Check Valve ❑ A�osphere Vacuum Breaker ����1 Maaufact�er ���'Q Siu Modei Iv�ber ��� Locaud At �r'!�'�c' �1�•�0 4�a� 1/�i c�1'� 5���,�ba N�1 ���5 w����. a� �,�e. REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check V alve Assembly lst Check 2nd Chec�: 'ef Valve Air Inlet Check Valve Inioal Test DGClosed Closed Tisht Opened at Opeaed at nsid g—J']—)(� Tight Leaked ❑ osid nsid RP- �=,� Dsid � ,� �'��� Leal:ed ❑ Did not Opea O Leal:ed � �� and Mataials Used , Test After DC-Closed Closed Tight O Qpeaed at Opmad at esid Repair Tight ❑ nsid nsid RP sid 1he above is certifiod to be true. Ficm Na�e Allied Flow Specialists, �nc. ���T� Christopher L. Coffman i F�A�SPO Box 1150 Midlothian,TX 76065 Cert.T�Si�No. BF'0016261 D� 8/17/16 �, Gauge # 05141063 Date last accuracy tested 7-21-16 White-Customer's Copy Yellow -City Copy Pink-Tester's Copy