Corbin MoyerT H C C I T Y O r
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OPPELL
City of Coppell Public Works Dept.
816 S. Coppell Road
Coppell, TX
75019
972462.5150
www,coppelltx,gov
BACKFLOW REGISTRATION FORM
Registration is for one year from the date ofregistration or re -registration.
Date of Registration � — � "t
Name:
Name of Company:
Mailing Addre
ss:
Physical Address:
� Number/PU Boxy
(Street d Number'Clty,
Office Phone Number: � 1-7- a 3 a - 5571
State and Zip)
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Moblte Phone Number. „ � I^� _ � �o P, ""' a $� —
E•mall Address: bY. LQ CLorrt.re,& N1ti . GOrr
DRIVER LICENSE
DL 22178656
les 01/22/2019
ma 12/20/1988
i 1110YER
CORRIN SPENCER
294 COUNTY ROAD 1678
BOYD TX 76023
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LICENSE NO.
18117
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TE)tAS COMMIS510N.QNENVIRONMENTAL QUALITY
C0RRIN,5 ,MOYEq
IS hereby Ilcens9d "as,u
IIACKI LOW•PRFVCNTIUN,1SSI,MIILY'I'CSTI'sR
11cense Number; Expires
BP0015385 07/12/2019
SIGNA RS
EXECUTIVE DIRECTOR
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EXE M P T R E G I S T R A T 1 0 N I
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MOYER, CORBIN SPENCER
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M/J PLUMBERi
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Expiration date:
`Card issuedMay 31, 2019 I
: May 04, 2018
M a CAr#Mur Gauge
MacArthur Gauge Inc,
1623 Baccarac Court
Euless, TX 76040
Instrument Calibration Report
Registration Information:
Brian Wagoner
Al Fire & Domestic Testing
PO Box 795458
Ft Worth, TX 76179
Manufacturer: Wilkins
Model: TG5
Serial Number: 06070576
Calibration Tag: 3557
Type: Differential Other:
Gauge Tested Within Tolerances: Passed
Reference Pressure/Reading:
0 psi = WA 5 psi = 5 10 psi = NIA
1 psi = 1 6 psi = WA 11 psi = WA
2psi= 2 7psi= 7 12 psi= WA
3 psi = NIA 8 psi = N/A 13 psi = WA
4 psi = N/A 9 psi = WA 14 psi = NIA
15 psi = WA
Calibration Date: 12/3/2018
Expires On: 12/3/2019
This gauge is calibrated to an accuracy of +/- .2 PSID
All test instruments used in the calibration of this gauge conform to ASME 840.1 and are traceable to N.I.S.T.
Service /Calibration Notes
Entry Type: •""**
NONE
Tested By: Zac Gates
Telephone: 817.685.0099 Fax: 817.283.1192 Web Site: