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2014_0508CIIECK ONE: IRRIGATION DOMESTIC FIRELINE BACTCFT.OW PREVEN'T'ION ASSEMBLY TEST AND MAIINTENANCE REPORT NAME OF Pws: CITY OF COPPELL / vvv d PWS I.D- # LOCATION OF SERVICE: � � � S - ft G The bac3cflow prcvmtioa assembly detai]ed below has bem tested anti **+a +•+r��*+ as required by TNRCC regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle C Pressure Va ��+n Breaker Double Check Valve � Atmosphere Vacuum Breaker / s� Manufacturer l.�/A � T S Size o Model Number � c' 7 d!'t � Located At s � � - L O � � � � Serial Ncmmber � / y 3 3 The above isc / ed to be true - Firm Name /Y /'T/ 6 //� J� / � � Certified Teste ��i �� �� l� � 3 � Firm Address � ®� ,ljvll 7 � � �✓� �ert Testa No. a Date Tx 751 lz ti Gauge # � G O Y/ 7Q� Date last accuracy tested /� �Y White - Customer's Copy Yellow -City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM B ItFAT�' R Double Chec3c Value Assembly 1st Chec3c 2nd Cheek Relief Valve Air Inlet Cbec3c Valve Initial Test DC- Closed � Tight �1. Closed Tight 1EC Leaked /, � O Opined at o sid Opined at o sid o sid RP- o sid c [7 Did noc Opm o Leaked '.� Repaus and Materials Used Test ARrs DC- Closed Closed Tight o Opined at Opined at o sid Repair Tight o n sid o sid RP sid The above isc / ed to be true - Firm Name /Y /'T/ 6 //� J� / � � Certified Teste ��i �� �� l� � 3 � Firm Address � ®� ,ljvll 7 � � �✓� �ert Testa No. a Date Tx 751 lz ti Gauge # � G O Y/ 7Q� Date last accuracy tested /� �Y White - Customer's Copy Yellow -City Copy Pink - Tester's Copy CIIECI� O�o IRRIGATION DOMESTIC FIRELINE / \ BACKFT.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF Pws: CITY OF COPPELL PWS I.D. # �� �?J ,p LOCATION OF SERVICE: � � l S_ /) G� ��;� The bae3.-flow prevention assembly detailed below has been tasted and **+a +'+t��*+ as required by TNRCC regulations and is certified to be operating within acceptable parameters. C Rcduccd Pressure Principle C Pressure Vacutmm Breaker ��Si Double Check Valve � Atmosphere Vacuum Breaker i� Maaufacnaer /l��'P �v rL � Size {�; /� � /� /¢ Located AL - � ^� � ; �� `Model Number �1 . �f . � = %s � � �'`�l' t, — � a E -`"` , Serial Number ���� r �-� �_ The above is certified to be trot. Firm Name J 7c 7 i ©w Y/ /L � Certified Tesur /��� fl c �` // � �f Firm Address I - G� 6c> >t 7 � T �r�� � •H � � Testa No. /J� Pp ©oo J�z Date S� � ��y � x 751�`� Gauge # r� G D `// � � �' Data Iast accuracy tested � - / 7 J � White - Customer's Copy Y�IIow -City Copy Pink - Taster's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM B R>�AF� R Double Chec3c Valve Assembly �::" "Relief Valve Air Inlet Check Valve 1st Check 2nd Cheel: Initial Test DC- Closed �. � Tight losed Tight Leaked },:t o Opined at v sid Opined at T n sid v sid RP- v sid Leaked a Did not Opm o Leaked � Repaus and Materials Used Test ARrr Repair DC- Closed Tigktt � Closed Tight O Opined at v sid. Opened at v sid v sid RP sid The above is certified to be trot. Firm Name J 7c 7 i ©w Y/ /L � Certified Tesur /��� fl c �` // � �f Firm Address I - G� 6c> >t 7 � T �r�� � •H � � Testa No. /J� Pp ©oo J�z Date S� � ��y � x 751�`� Gauge # r� G D `// � � �' Data Iast accuracy tested � - / 7 J � White - Customer's Copy Y�IIow -City Copy Pink - Taster's Copy CIIECK ONE: IRRIGATION � DOMESTIC FIRELINE l � BACKFI.OW PREVENTION ASSEMBLY TEST AND MA.I1V'TENANCE REPORT J NAME OF PWS: CITY OF COPPELL V PWS LD. # LOCATION OF SERVICE: �� -��_l _ 5 ��o The bacicflow prcvmtioa assembly detailed btiow has bem tested and •*+� +•+ta +*+ ed as rcquir+ed by TNRCC regulations and is certified to be operating within acceptable parameters_ TYPE OF ASSEMBLY c Reduced Pressure Principle c Pressure Vacuimm Breaker _^. Double Check Valve D Atmosphere Vacuum Breaks Maaufacttaer / � e � � o Model Number � mil' � Serial Number � ��/� s ° y Size Located At S_ G�/ - C� � �' 2 "�- The above is certifi to be true. f� Firm Name �� c' / � c w /�! x � Certified Testa ��� i /' e G � ��ifg �'t`S � �r� Firm Address /- � � � ° f 7 `� _7 �'✓°"} { � N � C«i Testa No. Lieu o010� Date s `'� .�. �i:� Gauge � Ci � O Y/ 7 � d Date last accuracy tested / � � �� White - Customer's Copy Yellow -City Copy Pink - Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACWM B REAKE R Double Check Valve Assembly 1st Check 2nd Checl: Relief Valve Air Inlet Cbecic Valve Initial Test DC- Closed I' '8 Closed Tight � Opined at Opined at n sid Tight � Leaked q ?., p � n sid n sid R.P- n sid Leaked o Did not Opm o r �9t Kt � �Pa� and Materials Used Test After DC- Closed Closed Tight o Opined at Opined at n sid Repair Tight o n sid n sid RP sid The above is certifi to be true. f� Firm Name �� c' / � c w /�! x � Certified Testa ��� i /' e G � ��ifg �'t`S � �r� Firm Address /- � � � ° f 7 `� _7 �'✓°"} { � N � C«i Testa No. Lieu o010� Date s `'� .�. �i:� Gauge � Ci � O Y/ 7 � d Date last accuracy tested / � � �� White - Customer's Copy Yellow -City Copy Pink - Tester's Copy CIIECK ONE. IRRIGATION DOMESTIC FIRELINE x � BACI�i.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: PWS I_D. # LOCATION OF SERVICE: � � � S. /z O �rr� The bacldlow prcvmtion 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 ���3 ��� _ Model Number � C tad Cheek Serial Number `1 % � J � j Air Inlet TYPE OF ASSEMBLY C Pressure Vacuimm Breaker C Atmosphere Vacuum Breaker Size Located AL S Gv c "o r f « �.c � ��- G�,,� � /� The above is c / ed to be true. �9� X� W ��i ya�S Firm Name / 7 C T � o .�- I � I � � Certified Tester f�b�• --�� "' Firm Address � �` � ° X � � 7 ��'¢� �,- TY Cert Tester No. bPo 0 o D Jain Date S _.� .> � ''1SIl.`� Gauge # Ur G O y! 7 Y �'' Date last accuracy tested � ' / 7 - � y CITY OF COPPELL White — Customer's Copy Yellow —City Copy Pink — Tester's Copy REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BlzF�r�'R Double Check Valve Assembly 1st Check tad Cheek Relief Valve Air Inlet Cheek Valve Initial Test DC- Closed Tight l `� 24 Closed Tight ffi Leaked / 8 o Opened at nsid Opined at nsid nsid RP- nsid ��;� C Did not Opm o Leaked C Repairs and Materials Used Test ARer Repair DC- Closed Tight � Closed Tight o Opened at nsid Opined at nsid nsid ItP rid The above is c / ed to be true. �9� X� W ��i ya�S Firm Name / 7 C T � o .�- I � I � � Certified Tester f�b�• --�� "' Firm Address � �` � ° X � � 7 ��'¢� �,- TY Cert Tester No. bPo 0 o D Jain Date S _.� .> � ''1SIl.`� Gauge # Ur G O y! 7 Y �'' Date last accuracy tested � ' / 7 - � y CITY OF COPPELL White — Customer's Copy Yellow —City Copy Pink — Tester's Copy