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2015_0826 IRRIGATION DOMESTIC FIRELINE� The following farm must be completed for each assembly tested. A signed and dated original � must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAiNTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) � MAILiNG ADDRESS: � �'a� S P��" �:�l��G �/��S lX• ��y� CONTACT PERSON/PHONE: 11� �i t i��S LOCATION OF SERVICE: �3 � �'�� The backflow prevention assernbly detailed below has been tested and maintained as required by commission regularions and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY JReduced Pressure Principle '1Reduced Pressure Principle-Detector -1DoubleCheckValve I IDouble Check-Detector :�1PressureVacuumBreaker f 1Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number � �� Size �� Located At �� Serial Number �l� 36/� Is the assembly installed in accardance with manufacturer recommendations and/ar local codes? �� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly � Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�-� psid Held at I � psid Opened at Opened at Held at Initial Test Closed Tighf� Closed Tight 1�(( psid psid psid Leaked. I Leaked' I Did not open ' Did not open 1 ' Leakedl Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�1 Closed Tight'� I psid psid psid ` v Test gauge used:Make/Model C�� p``�ciJ y�D�� SN: �? G��//7 pG Date Tested far Accuracy: 3-� l� Remarks: The above is certified to be true at the time of testing. Firm Name ��U'u'� ��1�� Firm Address / � �' 13c'�`` �� 7 L�`��f �y 7 f/�� Certified Tester(pr:nt) �� Certified Tester(signature) � Firm Phone# �U�� `�D� �� Cert.Tester No. �3��d 7� Date � a� �� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White- City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE�_ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAiNTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) ��6� S Pit>rr- �� `l � �Sod �l� MAILING ADDRESS: �l /-�� f �� CONTACT PERSON/PHONE: G/��- /¢- (.vi i� s /7 ' 3 7�' �7 LOCATION OF SERVICE: r',3 - ��'� i'�� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY '�:7Reduced Pressure Principle CReduced Pressure Principle-Detector C'�Double Check Valve ��Double Check-Detector C:PressureVacuumBreaker !Spill-Resistant Pressure Vacuum Breaker r� Manufacturer t� g� � Model Number �a �' Size $ Located At � '�`re �� Serial Number � 33 3 � Is the assembly installed in accordance with manufacturer recommendarions and/or local codes? �S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at 3� psid Held at f F' psid Opened at Opened at Held at Initial Test Closed TightXl Closed Tight�I psid psid psid Leakedl : Leaked[1 Did not open I ' Did not open f 1 Leakedf 1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight i ] Closed Tight .I psid psid psid Test gauge used: Make/Model C��'��o �a�� SN: OG O y/71� � Date Tested for Accuracy: � "� �l� Remarks: The above is certified to be true at the time of testing. Firm Name /%C��a r'� r�� '� Firm Address � �• �°X� 7�' � ��Xf�- 7J�- 7�� Certified Tester(pr nt)/�'�c ��`� Certified Tester(signature) �� QU ,- �.�G _v�.� �'� pQ O O�J 7l�d �'� f -/S Firm Phone# � Cert.Tester No. �/�/ Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White- City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) MAILING ADDRESS: SD a � 5 P�c�rc- � /le� /�,a//yt S T�/. �� y� CONTACT PERSON/PHONE: L /��' ' i/9/�s ' 77—?7�.1 LOCATTON OF SERVICE: / � � � � �i K r The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ]Reduced Pressure Principle GReduced Pressure Principle-Detectar -1 Double Check Valve C Double Check-Detector -�PressureVacuumBreaker ' 1Spi11-Resistant Pressure Vacuum Breaker �/ 3 Manufacturer r�� Model Number �6 r/ Size �� Located At �� ' ��f ��'f� Serial Number � 3aG y Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at �� psid Held at � � psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight �'� psid psid psid Leakedf� � Leakedl I Did not open '-�, Did not open f�� Leaked� � Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight L� ClosedTight C`i psid psid psid Test gauge used: Make/Model �d�h'��U ��G� SN: �� 1�11� � Date Tested for Accuracy: 3�G ��S Remarks: The above is certified to be true at the time of testing. fio�v I'/�t� j!O.l3oX 7 r�7 Gfi''�Xi�/_ Tx ��/G� Firm Name /�G Firm Address Certified Tester(pr:nt) �� SCertified Tester(signature) � Firm Phone# D�0� y sa l '�� 7Cert.Tester No. ��U� I D`'2 Date �,�L-� � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) � MaiLiNG aDDREss: Sao / S P,c�� U�//� ,�'� l/�s 7Y - 7 f.� Y� CONTACT PERSON/PHONE: �«'-�/� l�/i l/i/g S 7- 3 7 7 ' 7 LOCATION OF SERVICE: 1 3 S ��_ / 2/ /w� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C':Reduced Pressure Principle ��Reduced Pressure Principle-Detector C��DoubleCheckValve �ouble Check-Detector I 'PressureVacuumBreaker ' Spi11-Resistant Pressure Vacuum Breaker �J Manufacturer f� �C v Model Number ' �� ' Size � Located At � s��' �''}"�� Serial Number �3 3 3�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes?��S Reduced Pressure Princi ]e Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at 3 `�psid Held at �b psid Opened at Opened at Held at Initial Test Closed Tight�� Closed Tight ��'yC psid psid psid Leakedl��I LeakedC� Did not open I '�� Did not open I�_I Leaked'��I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight I:] Closed Tight' I psid psid psid Test gauge used:Make/Model C��b```�« �`" �� SN: ��d y��g 6 Date Tested for Accuracy: � `G �/ S Remarks: The above is certified to be true at the time of testing. Firm Name ��" �� e Firm A ddress �U' �j�X 7� � ��'"r�- 7x- �j/G� Certified Tester(print) ��`' �� Certified Tester(signature) � Firm Phone# ��a '�� '�� Cert.Tester No. ,(�� Date � �� s * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MarLIN�a��xEss: Soa� s,��,K (1`�-//� ,��//�s T� �s��Y coNTacT PERsoNiPHONE: Z i��'� Cv� /i�� 8l?- 3� 7- � �a� LOCATION OF SERVICE: / 3 S/ ,C. �"f z l ��t The backflow prevention assembly detailed below has been tested and maintained as required by cammission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C:_Reduced Pressure Principle �Reduced Pressure Principle-Detectar I.Double Check Valve �Double Check-Detector f PressureVacuumBreaker ,'Spill-Resistant Pressure Vacuum Breaker Manufacturer �c ��U - Model Number �� Size �� Located At � 5 ��1� ��l'/� Serial Number � ��G� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? t� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at l G psid Held at�psid Opened at Opened at Held at Initial Test Closed TightXf Closed Tight �� psid psid psid Leakedf'� Leakedl ' Did not open I �� Did not open ! I Leakedl I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight-] Closed Tight� I psid psid psid Test gauge used: Make/Model G6G�-d'��' ��`�p SN: a GO cl�� Date Tested for Accuracy: j-G ��S Remarks: The above is certified to be true at the time of testing. Firm Name � � ��o�`' �� Firm Address �d'/j� X �� 7 L�/'�' Xs�- TX- 7��"� Certified Tester(pr:nt)��/�t W��v��`t Certified Tester(signature) .> ��-�� Firm Phone# �� — �'�� ~ �� Cert.Tester No. �l P��}��a Date O 'aG�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy � IRRIGATION DOMESTIC � FIRELINE� The following form must be completed far each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) ,,/� MAILING ADDRESS: s�� s�'1� �/�!��I //� l�� rY- J S� �� CONTACT PERSON/PHONE: �� //9/x 5 �7 — 3 � 7 — 7 7�� LOCATION OF SERVICE: /3S/ �'- 4� � //�� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �-1Reduced Pressure Principle �Reduced Pressure Principle-Detectar �Double Check Valve C'Double Check-Detectar �PressureVacuumBreaker f:'Spill-Resistant Pressure Vacuum Breaker �i Manufacturer ��' 1�� Model Number 3 �� Size � Located At �� S ��e ��v �� Serial Number � 3 � �� Is the assembly installed in accardance with manufacturer recommendations and/or local codes?y�� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check L � Held at 3 psid Held at a psid Opened at Opened at Held at Initial Test Closed Tight�4 Closed Tight I� psid psid psid Leakedf '� Leakedl � Did not open I Did not open [I Leakedl ' Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight I 1 Closed Tight I� '� psid psid psid ��/. Test gauge used: Make/Model ��'��a �� SN: o 6�y�7�� Date Tested for Accuracy: 3`� `C 5 Remarks: The above is certified to be true at the time of testing. FirmName �7��d�"� ��K� Firm Address �O.�OX 7�C1 �/j`X'`� 7X Certified Tester(prsnt) /"`'/`�' ��`� Certified Tester(signature) god�SS��- �� d'� ��Papov�o� � -.a� -�y Firm Phone# Cert. Tester No. Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS � **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White- City Copy Yellow-Customer Copy Pink-Tester's Copy