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2014_0604 CHECK ONE: y( IRRIGATION DOMESTIC FIRELINE / BACI FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPF'ELL PWS I.D. # LOCATION OF SERVICE: 7 C-. 5 • lee, y / The bacidlow prevention assembly detailed below has been tested and mnirnrairted as required by TNRCC regulation and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle a Pressure Vacuum Breaker <- Double Check Valve 0 Atmosphere Vacuum Breaker /-- S ` ` 19 A Manufacturer u_/' Size Model Number % Located At S G /S G / Serial Number // 1 3. -- y REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAICER Double Check Valve Assembly 1st Check 1 2nd Cheek: Relief Valve Air Inlet Check Valve Initial Test DC-Closed . Tight l2( Opened at Opened at osid Tight �., Leaked 3"_ d 0 ________osid osid RP- vsid Leaked p Did not Open o Leaked U' Repairs and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at osid Repair Tight vsid vsid RP psid The above is certified to be true. Firm Name ."). - - 1 1 / O A /`/ X a Certified Testa //it, / �� M �..-t/ r Firm Address /9 _ /3 : x 7 7 111"/./ Tester No. /5" ).6' 2 Date G -- y -'Y n`Jf L.r4 Gauge # 69 G C 4 /1 7 C" 6 Date last accuracy tested - T ", 7 - 5" White - Customer's Copy Yellow - City Copy Pink - Tester's Copy CHECK ONE: �[ IRRIGA'T'ION DOMESTIC FIRELINE / - BACI FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT . P .:/// NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: G 3 6. ' S - A.07././ The bacldlow prevention assembly detailed below has been tested and maintained as required by TNRCC reeulations and is certified to be operating within acceptable parameters_ TYPE OF ASSEMBLY C Reduced Pressure Principle C Pressure Vacuum Breaker 1* Double Check Valve n Atmosphere Vacuum Breaker Manufacturer 0-1.4 / / Size /y Model Number 007 Located At 5 - L `v_ G/,-,- // Serial Number .- GJ 7 l ''2- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAK R Double Cheek Valve Assembly 1st Check 1 2nd Check _ Relief Valve Air Inlet Check Valve Initial Test DC- Closed Closed Tight KC Opened at Opened at vsid Tight / -7 Ite Leaked!; / o vsid osid RP- osid Leaked p Did not Open o Leaked rJ' Repairs and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at osid Repair Tight CI ______osid vsid RP_ psid The above is certified to be true- / /o/t �f Firm Name / / T,' ,f--- ,f--- / ---- / , r' Certified Testa ' /�� 1;1"./: ` �/ Firm Address / 6) fi 7!` 7 " ' 1 ) Cert. Testier No. fi Date 6. zi /7 '151 i.3 ( C.; � Gauge # C}6 O Sim 7 `f ' Date last accuracy tested 3 - 7 ''y White - Customer's Copy Yellow - City Copy Pink - Tester's Copy CHECK ONE: \ / IRRIGATION DOMESTIC FIR -MANE 7 BACI FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: 6 Q S 14 7 The bacldlow prevention assembly detailed below has been tested and rn.trt *Tined as required by TNRCC regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY c Reduced Pressure Principle a Pressure Vacuum Breaker X Double Check Valve n Atmosphere Vacuum Breaker /! � Manufacturer W/4 T ii f Size `� // L Mod-i Number 7 l Located At jts. i- !1�'li G '/ /T Serial Number REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREA.I ER Double Cheek Valve Assembly 1st Check 1 2nd Check Relief Valve Air Inlet Cheek Valve _ _ < — Initial Test DC- Closed . Closed Tight Pr Opened at Opened at psid Tight Z- 7 C Leaked '3.0 c psid nsid RP-_____psid Leaked a Did not Open o Leaked e Repairs and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at nsid Repair Tight c psid _______psid RP psid The above is certified to be true_ Firm NP ,1e r K- 7--- /•e a Certified Testa A` / ri4"/ /11 s9'4''.s Firm Address / '/.- . X `! "'CI )' 'f Cert Testa No. / /42) 49 ' ° 'z Date 6 // --"r y n Z51 tab Gauge # 06 L-' c-1/ 7 - Date ]last accuracy tested / �'7 �y White - Customer's Copy Yellow - City Copy Pink - Tester's Copy CHECK ONE: IRRIGATION DOMESTIC FIRELINE X BACICFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT xAlv>E of Pws: CITY OF COPPELL .Y PWS I.D. # LOCATION OF SERVICE: o �i o __CI X / The backflow prevention assembly detailed below has been tested and r iPinrained 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 C3 Atmosphere Vacuum Breaker ii ›- Manufacturer l�s'�} Size -- ` / Model Number ® C 7 �� / Located At 1 - a ` t Serial Number e= ` 7 G / a REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BRFAIC R Double Check Valve Assembly 1st Check 2nd Check Relief Valve Air Inlet Cheek Valve - > - -- Initial Test DC- Closed Closed Tight 17 Opened at Opened at nsid Tight <--e. l A Leaked o ? I O nsid nsid RP- nsid Leaked p Did not Open o Leaked 0 Repairs and Materials Used Test After DC- Closed Closed Tight a Opened at Opened at nsid Repair Tight o nsid nsid RP psid The above is certified to be true. / Firm Name / Tim fr`' 1----/ A C✓ Certified Tester j /71i ' ' e Z(/i /// y9",--e S Firm Address f�Q � ° )z 7 !' 7 1- X/ ' - Cert. Tester No. v/loo 0 a�°z is q � y '15i lo Gauge # e..) 6 O W - Date last accuracy tested 3 -,/ .7 3'15-i white - Customer's Copy Yellow - City Copy Pink - Tester's Copy CHECK ONE: IRRIGATION ) DOMESTIC ■IRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NA OF PWS: CITY OF COPPELL PWS I.D. # /� / /// ME LOCATION OF SERVICE: 6 �� S /' O y / The back/Flow prevention assembly detailed below has been tested and rr.ainrained 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 C Atmosphere Vacuum Breaker / / !t Manufacturer u� TES Size Model Number 1 :%' 6' 7 -bef / Located At �' Test Serial Number % a y 3 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly 1st Check 1 2nd Check Relief Valve Air Inlet Cheek Valve Initial Test Closed Tight ,1Q Opened at Opened at osid Tielat /� J Leaked � y o osid osid RP osid Leaked C Did not Open O Leaked C Repairs and Materials Used Test After DC- Closed Closed Tight a Opened at Opened at osid Repair Tight o nsid nsid RP psid _ The above is certified to be true. Firm Name / /i& / rl K Certified Tester / / 9 S ' C �' //i 1s / Firm Address Z / 7 Y7 a-7,1`x'`1- -77C ester No. /3"dodo 7D.'2- Date - y �y ''1_'?i (ai) Gauge # e2 e 0 c -// 7 c= cof Date last accuracy tested > 7 �y White - Customer's Copy Yellow - City Copy Pink - Tester's Copy CIICK ONE- IRRIGATION DOMESTIC FIRELINE BACI FLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT J- NAME OF PWS: CITY OF COPPELL PWS I.D. # // LOCATION OF SERVICE: The baclalow prevention assembly detailed below has been tested and mairirnined 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 C7 Atmosphere Vacuum Breaker L f i� Manufacturer /,&//. . / Size Model Number @ O 7 - " I I . t Located At fe'K Serial Number 6 /0 y l REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BR>: ASR Double Check Valve Assembly 1st Check I 2nd Check Relief Valve Air Inlet Cheek Valve Initial Test DC- Closed Closed Tight et Opened at Opened at nsid Tight � Leaked / G 0 nsid nsid RP- nsid Leaked p Did not Open o Leaked Repairs and Materials Used Test After DC- Closed Closed Tight o Opened at Opened at nsid Repair Tight a nsid nsid RP psid - - - - - The above is certified to be true. Firm Name /1G � ios� r� Certified Tester /'" L� //i I' S Fi rm Address / -eP, /Yo X 7 t1,.-1 X - Cert Tes a N o1 j,6•o6'GJ 7© -Z Date e - e/ / ‘e- Gauge # 6 o° !� Date last accuracy tested White - Customer's Copy Yellow - City Copy Pink - Tester's Copy