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2015_0920 C�IECK ONE: � IRRIGATION DOMESTIC FIRELINE� s�`� � � ' a � ';;` BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT � NAME OF PWS: CITY OF COPPELL ' ,, � � PWS I.D. # � , , LOCAT'ION OF SERVICE: : � i'.� �' ,,� s` ( :,� � `-� The bacl�low preveation assembly detailod below has baa iested aad maintain� � nq�� by TNRCC regulazions and is cerdfied to be operating within acceptable parameters. TYPE OF ASSEMBLY _ ..,_ _, C Reduced Pressure Principle . � � Pressur�,Vacu�Breaker: a � _ _ -: ;�_. �+i� =-� �_ _-� _ � - '�_ -�7bi�61e Ch�c�c�aIv� . -- _ � ' _�R�osp��ac�um Breaker-� -.___.� � Manufacturer t�r p � Siz� :, f , Modei Iv�ber `',� , � Located At t•'�� -i _, _fi =_ ;. '� j �_ A.-;. ��, � . _ �; , � e-_�- ek serial Nimmber °'� , - R�DUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R � Double Check Y alve Assembiy , t lst Check 2ad Checl: Rdief Valve Air Inlet Check Valve � Ininal Test DGClosed Closed Ti;ht � Opened at � Opeaed at esid � Tight ., ,., �i Leal:ed ❑ nsid �osid R.P- �.r''^ `' Dsid �;� p .. � Did not Open � Leal:ed � RePaus and Mataials . .-:_ .,._ _.�___;, _�.-�;:. �.,.._: ,�.__ -. --�: .� - _ �. - �-r - - .- - - .�. � . . d .� _.�r,. __ w --��.�: ,, __.� .._ _. Used _ - -- _ _R� . � - - � - - Test Ai�ex DC-Closed Closed Tight o Opeaed at Opeaod at __nsid Repair Tight ❑ flsid osid RP sid The above is certified to be true. Firm Name .; Cer�fied Testc �.�~ � , , _.. .� , . Firm Address . Cert. Testa No.r . ; t,. Date��: '�' ' � : C3auge # llate last accuracy tested ; . � , , White- Customer's Copy Yellow - City Copy � �;: Pink-Tester's Copy ,� C�IECK ONE: IRRIGATION DOMESTIC FIRELINE V' , � `: BACT�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT ;�" NAME OF PWS: CITY OF COPPELL a ' PWS I.D. # � , / , t� LOCATION OF SERVICE: ���I �`�-� ��i t I I"(���� � ��-�� � �% � � The bacl�low prevmtion assembly detailed below has bau test�ed aad maintained as required by TNRCC re_Qulaaons and is cctified to be operating withia acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressvrc Principle e Pressure vacu�mm Breaker � _. � . . r , __ �''..: �ubte�C��t�.a�ivo � :. --��_ � �- - E�e =�A�e+spher�Wacv�m-Brea�- _. >_.., =-- _ --_ :___v , : Maaufactiaer ���' S�.� Siu 7 , � Model Ivumber l��u^. �. Locaud At �l`��r_ -� :�' Scriai Ni�ber ���'� I�% .� � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly _ lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve Inival Test DGClosed Closed Ti;ht � Opened at Opened at esid r Ti�t � Leal:ed 0 �sid _nsid �-�T�">a �-�sid �;� a �' �' � Did aot Opea � Leal:ed � �P� and Materials U�-� a _ -- . _ -_ - _. -�- - . � � �: �.�_�, ��� �;-�._�„ .._ _ ._�,�..� ��.� »_-�.� -- �.. �-���- �.,;� z _� �-� ..�- _-� - .._- - � - Test ARer DC•Closed Closed Tight O Opened ai Opeaed at __nsid Repair Tight o �sid _osid RP sid The above is certified to be we. � Firm Name ��" ���t s j1 ��� � Certifiod Te.stc ��[ �jl 1 ���'L' � � � . Firm Address r�-�! ��'`��d� �'� Cert. Testc No.h��t%i'�5���/ Date�1�� Gauge # �;(� l � -� � �G llate last accuracy tested '1!/..�-�7 White- Customer's Copy Yellow - City Copy Pink-Tester's Copy _ _ __ __. __ _ __ _ ___ _ _ _ . C�IECK ONE: IRRIGATION DOMESTIC FIRELINE t.�°''" �� BACI4I.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT S �� CITY OF COPPELL NAME OF PWS: PWS I.D.# �: �:' . _. LOCATIOIv'OF SERVICE: `'���I CU• /�c' -{� % I ;�''�,`�� ,��.( `� f�� The bacl�low preveation asscmbly detaile� below has bcea tested and maintained as required by TNRCC regulauons and is cerdfied to be operating within accrptable paramtters. TYPE OF ASSEMBLY C Reduced Pressure Principle �; ❑ P�ssurc Wacuimm Breaker � �� :� � ��'.,�� �LllCr�l��.11 Y�VCi'"� '.,.'� � .: `� ..�;_ � _'. i���-F71G31A _..-.R ..y' `` _... .. . . . _ � _ . �.��n .. .._ T . ,.. � A! Maaufact�er �° �r)') r..r-. Siu . Modei Iv�ber � �%`'C' `' � Locaud At � u�-a�`�.,P � ��c�'� %' � Serial Nt�ber � / � � � �� .•�r c���" �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R ; Double Check v alve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inidal Test DC-Closed Closod Ti,,P.ht �i Opeaed at Opeaed at esid _ Tight ?�i Leal:ed o Dsid nsid .,;��p �� RP--�'�sid f, :'� / �;� ❑ Did aot Opea o Leal;ed o �P� aad Mataials . _ w , _ _. i3�td ` ". - - -- , ,_.� . . _ _ _ � � - - _-�- � - �. -- - _ _� � �: � - � � _ � h-�. _ , __ `,�. � v_�� -.:.. _ �_�� ,.� � _�-�- " � �_� Test After DC-Closed Closed Tight o ppeaed at Opeaod at __bsid Repair Tight ❑ nsid _osid RP sid The above is certifiod to be true. ,� Firm Name,��� S.�SI'�rjf �r�� � _ Certifiad Testc C 1 c. �!f� �-:�� �'� '" S. y ,l� F31m AYYf G13 /�7 � �fi'r_�y/ � . Cert. Taster No.�1/��'��>`'' � ��C�/!G����� ' GSUge # f' �r / 1�.J L}..�'U llate last accuracy tested � �✓-�1�'� ' White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE �'� r �� BACIQ�Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT � CITY OF COPPELL NAME OF PWS: . � PWS I.D.# � LOCATION OF SERVICE: _ _`���f G��� ����i� l� f�r--�• GC .=� l�-�' � The baclflow preveation asscmbly detailed below has beea tested and maintain� � nq� bv TNRCC regularions aad is cardfied to be operating within acceptable paramcters. TYPE OF ASSEMBLY C , Reduced Pressune Principle , . C Pressurc Vacuimm Breaker , _ a , _ . & ,. , -. t�' ,�itbk�fi�c�t V,alve-���,.., �. �r �►- hAl�mnsph�re��Tac�m:�n�lctr- .,- � .. _� �� Maaufactzaer ����r�i t� � � Siu � Model Ivumber ��' �'°��: �j�`� Located At � �� ���� 3`� p?i se� --a4�.� Serial Nimmber REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUCTM BREAI�R Doubie Check v alve-Assembly lst Check 2nd Checl: ReIief'Valve Air Inlet Check Valve Ininal Test DGClosed Closed Ti;ht yl� Opened at Opened at nsid Tight �7 Leal:ed ❑ csid _osid � ��, RP-�sid �,, � I,�;� ❑ � Did not Opea o Leal:ed J RePairs aad Mataials ���. , � ,�. , � , �.-y _ .:�,a„� .;.A � .: �. � . _ ;°--�` � ,, ._- ---.- - "$� w,... .�_; �_ ..._ , , . . ' : —� - .... - -� --� .: g,"—:. ' �-3: F.. ,_.. q. _.::__ , .--�'� �-�` ,—:�' - .— .-+} , -�._:� ' ._s^ �':`.._ :1 ...�_� _._� -_ � Test After DGClosed Closed Tight o Opeaed at Opeaod at �sid ' Repair Tight o �sid _._,osid R.P sid The above is cerdfied to be true. � ' Firm Name :1C ��'S1f��r �d� � __ Certifiod Tester c� ���r !�t'' t�'l �' , � :� � -�..,f; � � ' Firm Address ��'; /�'_.� 5'� � Cat Tester Nol��f��a/S-�� Date `1,��v / '"" ; 4 } : 4 :I � ��� r'y . � . . � (�auge # [,n�/..> � 4- � �-�' llate last accuracy tested 7,�1�/�/l� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE �./� ��' BACI�LOW P�tEVENT'ION ASSEMBLY TEST AND MAII�i'I'ENANCE REPORT ' R , ; ✓ NAME OF PWS: CITY OF COPPELL � � ;, PWS I.D. # � LOCATTON OF SERVICE: '�� :'�I �t�' � /J-�-��t k � h� �, ,� �( � ��� , The bacl�low prevmtion asscmbly detailed below has beea tested and maintained as required by TNRCC regulauons and is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY a e , �iu,� surc � �ple Pressure Vacu�Breaker : ; . � _", , 1�' F�ubk�:h�c Valv� ���s � .;-'_ � - �, ,, e���d�d-�ac�m'B" . � _ � ,, � _ - Maaufact�er G�(:r ����r l � S iu � � R Model Ivumber � �� � Located At c�'� � r�r e� Serial Nimiber C,� J � �' � � " REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Double Check Valve Assembly � lst Check ' 2nd Checi: Relief Valve Air Inlet Check Valve Inival Test DGClosed Closed Ti�t � Opened at Opeaed at nsid Ti�i i�1 Leal:ed ❑ __Dsid _1usid �, � f� RP-�sid �, t,l� �;� ❑ Did not Opm o L,ea1►ed o �P� aad Mataials „� , ,, �_ . � �.. �,; - ,� . _ � .�__` .► �., _ x - / . , . .. . - _�.. ��.��-r ,-.�i. v � �. . _ ..�.i-} ... , .,.� ._ _ - _.�fi _ _,. _,R, ::. V _ a. .� ' ,- - ... - , � Test After DC-Closed Closed Tight o Opeaed at Opeaed at _nsid Repair Tight o :nsid __osid RP sid The above is cerdfied to be ave. ;�: Firm Name �'e � � r1� ��L • Certifie�Tester �/G �"'1'� ���. C � � r Firm Address ��/ /G`��' � ' Cert. Tester No./�/�'�C>�5;�``"/ Date � �J U /� „ (�auge # ���.:/ � .��'� C) ;i � llate lsst accuracy tested ��/ S�/� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRItIGATION DOMESTIC FIRELINB ,f�'� � BACKFI.UW PREYENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��.�/� L''%� ��� 7�{i c I /`C c-�• L� �/�,--� , The bacl�low preveation asscmbly detailed below has beea tcsted and maintaincd as required by TNRCC regulations and is certified to be operaung within acceptable paramet�e�s. TYPE OF ASSEMBLY . , e �, �tCdu'c�Pr�s�e-_ ' le ;a .e P�ess�re Vacu�Breaker ' . � � � � _.. , _ _ � ' � �ble�I�1c Vaalvt�, . � >, �@x .t"�t, .: tA�'mosphe�'�,�c'�B�e� .a ' - � : � � / ' . ; Maaufacttaer !7�%'Sc� Siu � /Y � Locaud At ���� ' ,:��`� � Model Number � Scrial N�ber �'�G�L�,')'`�� �� �;c r -� :�.. REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSiJRE VACUUM BREAI�R � Doubk Cbeck�alve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Valve Initial Test DGClosed Closed Ti,Qht �d Opeaed at Opened at esid Ti�ht � Leal:ed o �sid osid ��y y x.P-�Sid ;�, L I,�;� ❑ -� Did aot Open o 1,ealced o RePairs _ aad Matenals ' _.( , � � �, ��ti .� `_ a _ � �, , k ' � _',' 'C.Isod �'� � � - � , , .w � - -x - .- -r° �. '� _ - -- -_ _ _ . . . � .._ . _ �� Test Aftu' DC-Clvsed Closed Tight o Opeaed at Open�at _�sid Repair Tight o osid �sid RP sid The above is certifiod to be true. f, . Firm Name /��C ��1�7-�rt;°s�j� � Certifiod Testa 1������ �` w,����/�i `� Firm Address �-S�� ��'`���� %.� Cert.Tester No�3��`-� �5 ��� Date `' �L'�/-� . ' . . � � � � :4 Gauge # _�-� �� / � .��--�C--�' llate last accuracy tested 7 ��7��/ White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iBCK ONE: IRI�IGATION DOMESTIC FIRELINE � BACKFLOW PREVENTIQN ASSEMBLY TEST AND MAINTENANCE REPORT NAN�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: `:��/� l Cr'- %�r. �I�.�.I ��l �L f 1 /�� The bacl�low prevmtion asscmbly detailed below has baa tested aad main ain� � nq� bv TT�IRCC reguladons and is cetified to be operating withia accrptablc paramcters. TYPE OF ASSEMBLY C Reduced Pressure Principle e Pressure Vacui�Breaker �'"" Double Check Valve o A�aosphere Vacuum Breaker � s Maaufacuaer �`����7�r � Siu Model Ivumber � �-'� �'� Located At !.( 6}�i���r��t�,l�C r�p�.7c.,��,� Serial N�ber �� � '�� � �`' �' REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Valve Ininal Test DC-Closed Closed Ti,Pht �( Opeaed at Opeaed at nsid Tight �7 Leal:ed ❑ �sid �nsid - f��y RP-�sid . �;� a � � Did not Open o Leal:ed o RePairs and Materials Used Tcst Aft�et DC-Closed Closed Tight o ppened at Opeaod at _,,,flsid � Repair TighL o :nsid osid RP sid The above is cadfied to be true. F /�?C �y��-c�.�,15 �7G • Certifiod Testet ��� �r r i �c4 r� G l � Firm Name_T Firm Address 7�/ /G °��' :.5'� Cat TGster Nol���''�'`'P��-� Date 1�' ?��1i`� Gauge # f���l 3 3 �`-� � llate last accuracy tested � /=��� 7 White- Customer's Copy Yellow - City Copy Pink-Tester's Copy