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2014_0306CIIECK ONE: IRRIGATION C-/ DOMESTIC FIRELINE BACMOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I.D. # CITY OF COPPELL LOCATION OF SERVICE. f-- I J96 ec !!�-n 1.5 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. ❑ Reduced Pressure Principle zr" Double Check Valve Manufacturer Model Number 7 5� C- T Serial Number 3 7 l TYPE OF ASSEMBLY C: Pressure Vacuum Breaker C7 Atmosphere Vacuum Breaker Size / Located At The above is certified to be true. Firm Name G� R� Certified Tester Firm Addrass -3 qyl Ct4 Cent. Tester NoI3 P60-415-4 Date Gauge # / Z Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1st Check: 2nd Check: Initial Test DC- Closed Tight RP -1�2-Ssid Leaked ❑ Closed Tight Leaked ❑ 7 Opened at osid Opened at pSid Did not Open ❑ pSid Leaked ❑ Reps and Materials Used Test After Repair DC- Closed Tight ❑ Closed Tight ❑ Opened at osid Opened at oSid oSid RP sid The above is certified to be true. Firm Name G� R� Certified Tester Firm Addrass -3 qyl Ct4 Cent. Tester NoI3 P60-415-4 Date Gauge # / Z Date last accuracy tested 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 back-now prevention assembly detailed below has been tested and maintained as required by TNRCC regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle C Pressure Vacuum Breaker C Double Check Valve C Atmosphere Vacuum Breaker Manufacturer Model Number Serial Number Size t , f Located At The above is certified to be true. Firm Name Certified Tester Firm Address Cert. Tester No. Date Gauge # Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1st Check 2nd Check: Initial Test DC- Closed Tight ❑ Closed Tight C Leaked ❑ Opened at Dsid Opened at osid osid lz - __psid Leaked ❑ Did not Open ❑ Leaked ❑ Reps and Materials Used Test After Repair DC- Closed Tight ❑ Closed Tight ❑ Opened at osid Opened at osid osid RP sid The above is certified to be true. Firm Name Certified Tester Firm Address Cert. Tester No. Date Gauge # Date last accuracy tested 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: eddieganl@sbcglobal.net City of Coppell TX 105 RIDGECREST CT This irrigation systemhas been installedin accordance with all applicable State and local laws ,ordinances, rules, regulations and orders. 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 1 � MA, 91 EDWARD GANDARA ............................. 3734 • Q, tiSFD � tRR��'P