David HofmannDate of Reglatratioi
Name: _.
Name of Company:
Mauing Address: _
Physical Address:
7 H C C f T Yor
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PPELL
►.: �,
City of Coppell Public Works Dept.
816 S. Coppell Road
Coppell, TX 75019
972462-5150
www.coppelltx.gov
BACKFLOW REGISTRATION FORM
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Vlabile Phone, Numbers
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Texas
DRIVER LICENSE
I.. 03119/201
s 10/16/1
6 LITTLE G CT.
MANSFIELD TX 76067
�e Exp 1 612024
it Restrictions NONE SoEnd.;,N.ONE
�. Hyt 5'-10" is Sex Wil ;
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s DD 06619880035119406339'
MacArthur Gauge
MacArthur Gauge Inc.
1523 Baccarac Court
Euless, TX 76040
Instrument Calibration Report
Registration Information:
1-A Fire &Domestic Testing
PO Box 79548
Fort Worth, TX 76179
Manufacturer: Mid -West
Model: 844P
Serial Number: 07020975
Calibration Tag: 3239 rTm
Type: Differential Other:
Gauge Tested Within Tolerances: Passed
R_ eference PressurelReading:
I0 psi = WA 5 psi = 5 10 psi = WA
1 psi = 1 6 psi = WA 11 psi = N/A
2 psi = 2 7 psi = 7 12 psi = WA
3 psi = N/A 8 psi = N/A 13 psi = N/A
4 psi = WA 9 psi = N/A 14 psi = N/A
15 psi = NIA
Calibration Date: 12/3/201 a
Expires On: 12/3/2018
This gauge In 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. ARRRA
NONE
Tested By: Zac Gates
Telephone: 817.685.Q099 Fax: 817.283.1192 Web Site: