2017_0221_RPZ CHECK ONE:
IRRIGATION DOMESTIC � FIRELINE
BACTCF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: Cl�'Y OF COPPELL
PWS I.D.# ZS Pharma Inc.
LOCATION OF SERVICE: 508 Wranqier Dr.
The bacl�low prevmtion assembly de�aile� below has baa testal and mainfain� � nq� by TNRCC
regulauons aad is cerdfied to be operating within accepublc paramcters.
TYPE OF ASSEMBLY
� Reduced Pressure Priacipie C Pressure Vacuum Breaker
� Double Check Valve ❑ Atmosphere Vacuum Breaker
' _ t � ,�a,
Maaufacnaer w�� Siu
Maiei Ivumber �FQ�I/�3.�� Located At 1r�t'2.�o;,�Sz a� �mC�ag� �-o,�.k5
Sezial N�ber � �1 1 ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V AC[TtJM BREAI�R
Double Check Va1ve Assembly
Ist Check 2ad Checl: Reiief Va1ve Air Initt Checic Valve
Iaitial Test DC-Closed Closed Tight ❑ Opened at Opeaed at nsid
Tight o Leai:ed nsid osid
�_ O•Q'Ds�a �- Q 1�q k�n+�
�A�� �aj ' .1 DIC�IIOi�CII O L�C3�Od O
�� C�e.anc.� ���h o �e�';5!
�d �n��l� ck.bb�' �c k��-- -
Mataials
Used
Test Atter DC-Closed Closed Tight �ed at Openod at nsid
Rep ' Ti�j �' /� � flsid nsid
RP '<� � sid
Tbe above is catifi�to be tcue.
Firm Name Allied Flow Specialists, Inc. Cettified TaSter Christo hp er L. Coffman
�'� Fi�mAddressPO Box 1150 Midlothian,TX 76065 C�,TesterNo. BP0016261 ��
' �-�I-1�'
�i Gauge # 05141063
Date last accuracy tested 7-21-16
I� White-Customer's Copy Yellow - City Copy Pink-Tester's Copy
C�iECK ONE:
IRRIGATION DOMESTIC � FIRELINE
BAC`I�Z.OR'PREVENTION ASSEMBLY TEST AND MAINTENANC'E REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D.# ZS Pharma Inc.
LOCATION OF SERVICE: 508 Wranqler Dr.
The bacl�low preveation asscmbly detaile� below has bxa tesud aad II13intain� � required by TNRCC
rcgularions aad is certified to be operating withia acceptablc parameters.
TYPE OF ASSEMBLY
� Reductd Pressurc Principlc ❑ Pressure Vacumm Breaker
� Double Check Valvc o Atmosphere Vacuum Breaker
Maaufacturer
��,r�-� s� ���
Model Ivumber . LF RO`3 Locat�d At W��1�ug� °� S�oC�19e. tQsUCs
Serial N�bc Q�$3'�'D
REDUCED PRESSURE PRINCTPLE ASSEMBLY PRESSURE VACUUM BRF.AI�R
Doubie Check Valve Assembly
lst Check :nd Checl: Rdief Valve Air Iniet Chetk Valve
Inival Test DGClosed Closed Tight �at Opmed at osid
Ti Leal:ed o C�7' v psid nsid
��� RP�'�Dsid
j,�;� p �' � Did not Open O Leal:al D
��
aad
Materials
Uscd
Test Afttt DC-Closed Closed Tight � Opeacd at Opeaod at nsid �
Repair Tight o flsid osid
Rp sid
The above is cati6ed to be true.
Firm Naaee Allied Flow Specialists, inc. CertiSed Testa Christopher L. Coffman
'� Fn"�A�i�SSPO Box 1150 Midlothian,TX 76065 Cert.TestcNo. BP0016261 D��'��y��
!, Gauge # 05141063
II, Date last accuracy tested 7-21-16
White-Customer's Copy Yellow - City Copy Pink-Tester�s Copy
C�IBCK ONE:
IRRIGATION DOMESTIC � FIRELINE
BACIQ�'LOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPOR?
NAI�OF PWS: CITY OF COPPELL
PWS I.D.# ZS Pharma Inc.
LOCATTON OF SERVICE: 508 Wranqler Dr.
Thc bacl�low prevention asscmbly detailed below has bxa testcd and maintained as requirt� bv TNRCC
regulations aad is certified to be opezating withia acceptable parameters.
TYPE OF ASSEMBLY
� Reduced Pressure Principie e Pressure Vacu�Breaker
❑ Daublc Check Valve D Auaosphere Vacuum Breaker
Maaufacturer ��+��� Siu ���'�
Modellvumber LF�q/1��T LocaudAt �t�P,�a�.S� , Sco�9e, '��I�CS
Serial Nmmber �����
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check�alve Assembly
ist Check 2nd Checl: 'ef Valve Air Inlet C6eck Valve
Inival Test DC-Closed Closed Tight at Opeaed at nsid
Tight Leal:ed o C�� sid osid
RP-�g�sid �.(ft
QG'�`,�:� �;� p Did not Opea � Leal:ed J
��
aad
MataiaLs
Usod
Test Af3er DC-Closed Closed Tight o Opeaed at Opeaed at nsid �
Repair Tight o flsid osid
RP sid
The above is catifiod Lo be tiwe.
F�N� Allied Flow Specialists, inc. Cercified Testc Christopher L. Coffman
'� Fl�A�T�CSSPO Box 1150 Midlothian,TX 76065 ��,Testa No. BP0016261 D� �`��—� !
I Gauge # 05141063
, Date last accuracy tested 7-21-16
I
White-Customer's Copy Yellow - City Copy Pink-Tester's Copy