2014_0306CHECK ONE:
IRRIGATION
DOMESTIC
FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS:
PWS I.D. #
CITY OF COPPELL
LOCATION OF SERVICE: /D Z tP6.� C/l c �/ C-r
The back-flow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable parameters.
C Reduced Pressure Principle
Double Check Valve
Manufacturer��g
Model Number
Serial Number PG q Z ( 33
TYPE OF ASSEMBLY
❑ Pressure Vacuum Breaker
C Atmosphere Vacuum Breaker
Size A/ y
Located At
The above is certified to be true.
Firm Name C:� l'�/° 2iA- 4,
Firm Address
Gauge # 3 t 2 e "
Date last accuracy tested
12-57-( -?
Certified Tester
Cert. Tester No. 6h0J- 3rd Z Date —4� 1
1
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
PRESSURE VACUUM BREAKER
REDUCED PRESSURE PRINCIPLE ASSEMBLY
Double Check Valve Assembly
1st Check
2nd Check:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Ti
Closed Tight
Leaked ❑
Opened at
osid
Opened at
nSid
nsid
RP .psid
Lca;ed ❑
Z�f
Did not Open ❑
Leaked ❑
Reps
and
Materials
Used
Test After
Repair
DC- Closed
Tight ❑
Closed Tight ❑
Opened at
vsid
Opened at
nSid
nsid
RP sid
The above is certified to be true.
Firm Name C:� l'�/° 2iA- 4,
Firm Address
Gauge # 3 t 2 e "
Date last accuracy tested
12-57-( -?
Certified Tester
Cert. Tester No. 6h0J- 3rd Z Date —4� 1
1
White - Customer's Copy Yellow - City Copy Pink - Tester's Copy
CHECK ONE:
IRRIGATION
DOMESTIC
FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:
The baclflow prevention assembly detailed below has been tested and maintained as required by TNRCC
regulations and is certified to be operating within acceptable par=eters.
TYPE OF ASSEMBLY
❑ Reduced Pressure Principle ❑ Pressure Vacuum Breaker
❑ Double Check Valve ❑ Atmosphere Vacuum Breaker
Manufacturer Size
Model Number Located At
Serial Number
The above is ccrttified to be true.
Firm Name
Firm Address
Gauge # 1 f /
Date Last accuracy tested
Certified Tester
Cat. Testa No. Date
White — Customer's Copy Yellow — City Copy Pink — Tester's Copy
REDUCED PRESSURE PRINCIPLE ASSEMBLY
PRESSURE VACUUM BREAKER
Double Check Valve Assembly
1st Check:
2nd Check:
Relief Valve
Air Inlet
Check Valve
Initial Test
DC- Closed
Tight ❑
Closed Tight ❑
Leaked ❑
Opened at
Dsid
Opened at
osid
nsid
It -_psid
Leaked ❑
Did not Open ❑
Leaked ❑
Reps
and
Materials
Used
Test After
Repair
DC- Closed
Tight ❑
Closed Tight ❑
Opened at
osid
Opened at
vsid
nsid
RP sid
The above is ccrttified to be true.
Firm Name
Firm Address
Gauge # 1 f /
Date Last accuracy tested
Certified Tester
Cat. Testa No. Date
White — Customer's Copy Yellow — City Copy Pink — Tester's Copy
GANDARA IRRIGATION INC.
3901 Clifton Dr. Richardson TX 75082
Office: 972 - 671 -3776
Fax: 972 - 664 -9158
Cell: 972 - 467 -3918
Email: eddiegan1 @sbcglobal.net
City of Coppell TX
102 RIDGECREST CT
This irrigation systemhas been installedin accordance with all applicable
State and local laws ,ordinances, rules, regulations and orders.
I have tested the system and determined that it has been installed according
to the irrigation plan and is properly adjustedfor the most efficient
application of water at this time.
1 year warranty from the day of installation.
EDWARD GANDARA
- 'F vcE
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