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CHECK ONE: /
IRRIGATION
DOMESTIC
FIRELINE
BACxFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: CITY OF COPPF,LL
PWS I.D. #
LOCATION OF SERVICE:
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.
TYPE OF ASSEMBLY
C Reduced Pressure Principle C Pressure Vacuum Breaker
❑ Double Check Valve Atmosphere Vacuum Breaker
Manufacturer Size
Model Number Located At
Serial Number
The above is Certified to be true.
Gandara Irrjgation
Firm Name 3901 Ci�ton Dr
Firm Address
Gauge #
Date last accuracy tested
Certified Tester
Cat Tester No. Date
White - Customer's Copy Yellow - City Copy
I
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 C
Closed Tight C
Leaked o
Opened at
osid
Opened at
psid
osid
Sid
Leaked Leaked C
Did not Open o
Leaked
Repairs
and
Materials
Used
Test After
Repair
DC- Closed
Tight G
Closed Tight o
Opened at
nsid
Opened at
oSid
nSid
RP Sid
The above is Certified to be true.
Gandara Irrjgation
Firm Name 3901 Ci�ton Dr
Firm Address
Gauge #
Date last accuracy tested
Certified Tester
Cat Tester No. Date
White - Customer's Copy Yellow - City Copy
I
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
109 RIDGECREST CT
To Whom it May Concern;
An irrigation system was installed at the property described above. In accordance with
the city of Coppell inspection requirements, we are providing the following information.
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 adjusted for the most efficient
application of water at this time.
1 year warranty from the day of installation.
Sincerely
EDWARD GANDA A
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EDWAPD " ANDARA
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