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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 d2ld. .......... ..NN..N