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2014 Backflow Reports C�iECK UNE: IRRIGATION DOMESTIC FIRELINE �✓ BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NANtE OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE:/�°ti°�t c c.�I,;�r"��Q��-' ��D/�� ,�P.iJ,��.��y The bac�low preveation asscmbly detailed below has becn tested aad ma�nta�n� � nq� by TNRCC regulanons and is cerdfied to be operating within acceptablc paramtters. TYPE OF ASSEMBLY c Rcduced Pressure Principlc ❑ Pressurc Vacui�Brealcer ,� Double Check VaIve ❑ Atmosphere Vacuum Breal:er �l L �/ Maaufact�er /7/YI�S Siu � Modei N�mmber �/j lJ�f Located At � S," 'a�vl , G'��,r iz 6• Scrial N�ber �C'N'� �S % _ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULJM BREAI�R Double Check Yalve Assembly lst Check 2ad Checl: Relief�alve Air Inlet Check Valve Ininal Test DGClosed losed Ti�ht Opened at Opened at osid Tisht. Lcal:ed o �sid osid �- 1�� Ds�a F Lealxd o � �� Did not Open o Leal:ed � �P� and Materials Used Test Aft,er DC-Closed Closed Tight o Opened at Opeaed at _nsid Repair Tight o �sid osid R.P sid The above is certified to be we. Firm Name OyI tt'O ( ,a�!'Iln _ CeRified Testa � Y'r S`I(,Uf� Firm Address p_��G�,[�2 Y1L.� Cert. Tester No. �U4o 5'IG�qDate J� � � Tx 7C�6 q� c�suge # c�8D�lU 8� llate last accuracy tested � � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATTOIv'OF SERVICE: /��_��'1 i�,� ra�t' � L�� (P�D�C'cdnr/1��;� �S l� The bacl�low prevcation asscmbly detaile� below has beea tesud and maintained as required by TNRCC regulauons aad is ceiti5ed to be operaung within acceptable paramcters. TYPE OF ASSEMBLY ❑ Reduced Pressure Principle ❑ Pressur�Vacu�Breaker � Double Chxk Valve o Atmosphcrc Vacuum Breal:er y� l� Maaufact�uer �/`t�,.,�S Siu ,-� Modei N�ber ,�/f >�/� Locaud At c1��5�d' �G�')%yl�i'�:�� Scrial Nimmber �(�'(�' ' �� 7 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULJM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Reiief Valve :�ir Inlet Check Valve Initial Test DGCloscd Closed Ti�t Opened at Opened at osid TiQht Leal:ed ❑ nsid osid R.P•�� Dsid � i G L,�;� p Did not Opca o Leal:ed � �P� and Materials Used Test Aft�er DGClosed Closed Tight o Opened at Opeaed at nsid Rcpair Tight o �sid osid RP sid The above is c«tified w bc true. Firm Name�l�t_�"'1L.�-�"12'��11-- Cctified Testc �G 1�Yr� r�ha L Firm Address��Bli��7�f�'D, P� Cert. Tcster No Date T� ��o��i Gauge # (�Q(Zy� ,SG Date last accuracy tested� % � White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIftELINE � BACI�Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE:/��ct�,<<i ,�c,;��B Lc;��/�0�, C c�,�I�,EJ�L� ��C�I� The bacl�low prevmtion assembly detaile� below has been tested and mainta�n� � nq�� by TNRCC rcguladons aad is cerd5ed to be operating within acccptable paramcters. TYPE OF ASSEMBLY C Rtduced Pressurc Principle ❑ Pressure Vacu�Breaker � Double Chxk Valve o Atmosphere Vacuum Breal:er � �l Maaufacturer �� Sizc Modei N�ber �I'�(J Located At ,�,5'� Y l� �� Serial N�ber d�-�t5 Fi��i+ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CULTM BREAI�R Double Cherk Valv�Assembly lst Check 2nd Checi: ReIief Valve Air Inlet Checic Valve Inival Test DGCloscd Closed Ti;hc Opened at Opened at esid Tight Leal:ed 0 �sid osid R.P- �'�Dsid �;� ❑ �'� Did not Opca o Leal:ed � �P� and Materials Used Test Aft,er DC-Closed Closed Tight o Opened at Opmod at nsid Repair Tight ❑ nsid osid R.P sid The above is cati6ed to be true. Firm Name '"!��"'r_.d__(T�— CatiSod Testa��'tn .S,�h.D,� � Firm Address PD/�l 7 >��ii� � Ccrt. Tcsta No. Date� �'x 7�ogq c8uge # ��t/o �d llate last accuracy tested 3 Cv White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK OloTE: IR.RIGATION DOMESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NANtE OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:/�' ' uj��uD� �/j�� a,��/��a�2a��/��-jaf � The bacl�low preveation assembly detailed below has bxa tested aad IIl�n ain� � nq� bv TNRCC regulazions and is cerdfied to be operating within acceptable parameters. TYPE OF ASSEMBLY C Rcduced Pressure Principle ❑ Pressurc Vacu�Breaker �e"' Double Chxk Valve o Atmosphere Vacuum Breaker r� �/ Maaufact�cr l��I!'� Siu , �G Modei N�ber �� Located At �`,S�r ra�,�/�``�3 Serial N�ber ��..L_� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSi.TRE VACULTM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: ReIief valve :�ir Inlet Check Valve Inival Test DC-Closed Closed Ti�t Opened at Opeaed at osid Tisht Leal:ed ❑ �sid osid xp-1�.ps�a 1, �" I,�;� ❑ Dia noc Opea o Leal:ed o �� and Materials Used Test Af3er DC-Closed Closed Ti,Qht o Opened at Opme�at �sid Repair Tight ❑ nsid osid RP sid The above is certifiod to be true. � Firm Name ��1`�o Cd/�I1/I•— Catified Testes � 2 r Firm Address PD�/�� sr'�,a��hnc Cert. Testa No.�l°rJO�'l Date I r ��o�'�, c�suge # O�0 y0�S� llate last accuracy tested�/J /,�� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: LRRIGATION DOMESTIC FIRELINE�� BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE:��n t�.s,��, t�� L��c�. ��'/U, �o.r��/��/� The bacl�low preveation asscmbly detailed below has beea tesud aad maintained as required bv TNRCC regulazions aad is cerrified to be operating within acceptablc paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Pressure Vacuimm Breaker � Double Check Valve [7 Atmosphere Vacuum BreaL-er � J� Manufact�uer ,��r�.,� Siu �- Model Ivumber ,�U�i�,� Locatcd At �/',��'��"�'�i�J Scrial N�ber ,�.�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Reiief Valve Air Inlet Checic Valve Inival Test DGCloscd Closed Ti;ht Opeaed at Opeaed at esid Tisht , Leal:ed o Dsid osid RP- �oZ sid � L.eaked ❑ �'L Did not Opea o Leal:ed � �P� and Mataials Used Test A,fter DGClosed Closed Tight o Opened at Opeaod at osid Repair Ti,Qht ❑ �sid osid RP sid The above is certifiod to be true. Firm Name ��"P o l n/y►y,ili Cctifiod Testa �G YY � S d�Cil/. Firm Address� G' 1 Uryl�° Cert. Testa No.�p Date / // Tx �1�4��1 Gauge # (' ' f�5/�D �D llate last accuracy tested ,�� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRItIGATION DOMESTIC FIRELINE BACKFLOW PREYENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAI�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE:/pea��,�4��L.c;.�G ��/�I, r�� l�i�i' 7�d 1 � The bacl�low prevmtion asscmbly detailed below has beea tested aad maintain� � nq� bv TNRCC regulauons and is cerdfied to be operating within acceptablc paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle ❑ Pressure Vacut�Breaker e�' Double Chxk Valve o Atmosphere Vacuum Breaker �/ � 1/ Maaufactiaer ///�Z �i� Siu Model Number ��'i Ci l.3 Located At rd'S!'Y r��c� �� Seriai N�ber �d� ,��_ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly ist Check 2nd Checl: Relief Valve Air Inlet Check Valve Initial Test DGClosed losed Tight Opcaed at Opened at csid Tight � Leal:ed o nsid _,osid �- � S�a /; s ° �;� o Dia noc Opea o L,eal:ed n �Pairt and Matcrials Usod Test ARet DC-Closed Closed Tight o Opeaed at Opeaod at _nsid Repair Tight ❑ �sid osid RP sid The above is catifiod to be true. Firm Name�'I�y''re _a , CatiSed Testa �Y �C'u� , Firm Addressp��'.�G7�»-r��.-_��'%� Cat Taster No.��/��raS'' Date��Ly cg� � a �o yv xsv llate last accuracy tested !� �l White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE��j�c L.r�� ►.2C�J�, C'�i D/l��'��a�C�/ ��/� The bacl�low preveation assembly detailod below has beea tesced aad maintained as required by TNRCC reeulauons aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressvre Principle ❑ Pressurc Vacu�Breaker ;�'" Double Check Valve o Atmosphere Vacuum Breal:er � �L Maaufact�er ��'l n � Siu Modei N�ber ,�lJ d� � Located At r'l�S'L'.Y YmB��(�' s«��N�ba ��`/'y�y REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve Inival Test DGClosed Closed Ti,Pht Opeaed at Opened at esid Ti�t Leal:ed ❑ �sid osid x.P-�.ps�d J x. I,eai;ed o � Did not Opea o Leal:ed o �P� and Materials Usod Test Aft,er DC-Closed Closod Tight o Opeaed at Opeaed at �sid Repair Tight ❑ osid osid RP sid The above is cati6ed to be t�ue. Firm Name��L'i�"1'!! �O!!'!'!.�'12-._ Certifiod Testa �e� ��4�'� Firm Addres.sf'a�.�(�7 G-�tiac v�,�,�7�ar5�'�' Cert. TGster No� Date 11�1�� (�auge # � ��.S 0 llate last accuracy tested / a White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iBCK ONE: IRRIGATION DOMESTIC FIRELINE v BACIQ�Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:�� .s .�� `.��D�� / /�d�� The bacL-flow prevmtion asscmbly detailod below has baa tested aad maintained as required by TNRCC regularions and is cerdfied to be opera�ng within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle C Pressure Vacuimi Breaktr ,2� Double Check Valve o Atmosphere Vacuum Breaker � J/ Manufact�er '0 Siu Modei Ivumber ^Z�d CI ./� Locacad At Y'�`SG�' Yal��y �� Scrial Iv�ber l'D��S��a REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Double Check Valve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Valve Ininal Test DC•Closed Closed Ti�t Opened at Opened at nsid Ti Leal:ed ❑ _�sid osid RPQ��sid �f '�, �;� ❑ �`` � Did not Opea o Leal:ed O �� aad Materials Usod Test ARer DC-Closed Closed Tight o Opeaed at Opmed at �sid Rep$ir Tight o �sid __nsid RP sid The above is cerdfiod to be true. Firm Name��"/�7�d 0 Cv/N�►'1. Catifiod Tester�c Y Y�l SC�U C/�-- Firm Addressl�o�i_�nti�.Z��l�f' Cert Tester No. 4� Date 1�,�� Gauge # Cj Si'b y'0 �(S 4 llate last accuracy tested White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IR.RIGATION DOMESTIC FIRELINB � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAN�OF PwS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:/�t�TT� � > �L�C��/�` .r�n //�f':I � �/g The bacl�low prevmtion assembly detaile� below has beea tested aad ID�1*Lta�nCd as required bv TNRCC regulations aad is certified to be operating within acccptable parameters. TYPE OF ASSEMBLY C Reduced Pressurc Principle ❑ Pressvre Vacuimm Brealcer � Double Check VaIve ❑ Atmosphere Vacuum Breal:er /f Maaufactsaer �/�� G�'� Siu � Model Iv�ber ,� �� Located At YfS�'r)"DUA'!��Si�� Scrial N�ber C�DC�/S 3� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly ist Check 2nd Chec�: Relief Valve Air Inlet Check Valve Ininal Test DGClosed Closed Ti,Qht Opened at Opeaed at ,nsid Tight Leal:ed o osid osid R.P-�sid Leal;�d a �"�� Did not Opea o Leal:ed o �P� and Materials Usod Test Aftet DC-Closed Closed Tight o Opened ai Opmed at _�sid Repair Tight ❑ osid osid R.P sid 'Ibe above is certified to be we. Firm Name/�a r"�o C�mm_ Cerdfied Testa � .�r r�, �� /� Fiim Address�0l�/1(.7�v-�r.r.«�;,c_�'�C9�'f' Cert. Testec No.��OU�'(o(0 9 Date La2,��?1� Gauge # �S�'CJ�f 1�,�',��J llate 18st accuracy tested White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE ✓ BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:�t G .�1 rr► •f' E . p �.�f l(�.C�,��G/g The backflow prevmtion asscmbly detaile� below has beea testod aad main ain� � nq� bv TNRCC regularions and is certified to be operating within ac�eptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle C Pressure Vacutmm Breatcer � Double Check VaIve o Atmosphere Vacuum Breaker ��Y_' Maaufact�er /'n @,f Siu Model Ntmnber .�/�/�C�/.3 Located At �'v`SG r �'�o:n.�%5`�`9 Serial N�ber �f�� _ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Cbeck v alve Assembiy lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed Closed Ti;ht Opened at Opened at nsid TiQht Leal:ed ❑ �sid _osid R.P-�sid ., �;� ❑ � � � Did not Opea o Leal:ed � �P� and Materials Usod Test After DC-Closed Closed Tight O Opeaed at Opm�d at _�sid Repair Tighi o �sid _nsid RP sid The above is cectifiod to be true. z Fiim Name��7'f'�� t�YJ Certificd Teste ��L ��' �� tiI �e� �'v� Fi�Addressr'oBi?G7�,�n��.��c !} 7GUYpCat T�No.�3A�vcr�'� �9 D� Gauge # G�G t/!)3►''t`!� llate last accuracy tested� U White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: ,� � IRItIGATION DOMESTIC FIRELINE BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE:/l°e.�anT�� L��p G�i�C��J4�,/ � SO/� The back-flow preveation assembly detaile� below has beea tested aad maintained as required by TNRCC regulauons and is cerdfied to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressure Principle e Pressure Vacu�Breaker � Double Check Valve o Amiosphere Vacuum Brea�er Manufact�er n s� � �> Model Number ��U(� � Located At �''y�S��' Y'0 a�''�?�y`�fG� Serial N�ber ��D/�� REDUCED PRESSURE PRINCTPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check v alv�Assembly lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve Inival Test DGClosed Closed Tight Opened at Opeaed at osid Tight Leal:ed o nsid osid �_.�S�d /,g �;� o Dia noc Opea o L,eal:ed � �P� aad Materials Usod Test Aftet DC-Closed Closod Tight o Opened at Opeaed at �sid Repair Tight ❑ esid osid RP sid The above is certifiod to be true. Firm Name ��T�� Qi�iA't . Cerrified Te:stc ��t?r r z-1 �Cl1Qv 1/ Firm AddressP�!��= �` 4 7 ' �Y Cert.Testc No./��,�'lof 4 Date 1�� Gauge � �f�'C��%D �a' llate last accuracy tested�l� l0 White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE �l BACKFLOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT' NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:/'�°� u �4��i c�c � la,�l�/G''� �ia�;n�� 7�� The bacl�low preveation assembly detailed below has beea tested and maintained as required bv TNRCC rer�ulations aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressiue Principle ❑ Pressurc Vacui�Breaker � Double Chxk Valvc o Atiaosphere Vacuum Bnaker � l/ Maaufacturer � Siu Model Number ��1��.�j Located At tr�se r ror m �/��1/ s«ial Ni�ber (�/'�/�/��l� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DGClosed Closed Ti�t Opened at Opened at osid Tight Leal:ed ❑ Dsid _flsid R.P-�,psid , � o J g �a nat op� o r.�;�a � �� a Mataials Used Test After DC-Closed Closed Tight o Opeaed at Opeaod at __�sid Repair Tight � nsid _,_,vsid RP sid The above is cctifiod to be true. Fiim Name ��°�"�`v C��'1/•+� Certifiod Testa ��G�J��/G� FitmAddress�D/�% L7(�r�»r,v��n,�,��rr9Cat Testallo.,�P�ao�r�� n�� Gauge #(��112�.� llate last accuracy testea/J White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iBCK �NE: IRRIGATION DOMESTIC FIRELINE � BACI{FZ.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAI�OF PwS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE:OeG'��r.��,,�� (��D�_,�,��1��"D /9 The bacl�low prevmtion asscmbly detailed below has beea tested aad ma;*+t�ed as required by TNRCC regulations and is certified w be operating within acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Pressure Vacuimm Breaker 2� Double Check Valve o Atmosphere Vacuum Breaker � ll Maaufacturer � Siu , Model Number �� Located At 1"�S�r YGd�'1�5�1� Serial Nimmber � �. �.2� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Valve Ininal Test DGClosed losed Ti.,,pht Opened at Opeaed at esid Ti�ht � Leal:� ❑ vsid _�sid R.P-�psid � I,�;� ❑ � Did not Opea o Leal;ed O �P� and Materials Used Test After DC-Closed Closed Tight o Opeae�at Opeaed at _nsid Repair Tight ❑ esid _nsid R.P sid The above is certifiod to be true. Firm Name��J'"/'o ��irttYl, Cerdfiiod Teste �e r r� �Gv1! Firm Address��3 J.?G��G r��v�:r�T?�a g 9 cac. r�xo.Bl� ��rvS� Date�r��/ Gauge # (��fjS o llate last accuracy tested JQ l(� � White - Customer's Copy Yellow - City Copy Pink -Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACI�LOW PREYENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE�c��cu �ul"s�i��c,�,o�0/�, �`c��a�J�G��I�� 1' � The bacl�low prevmtion assembly detailed below has beea tested aud ma�n ain� � nq� bv TNRCC regulazions aad is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Pressure Vacuimm Breaker � Double Chxk VaIve � Amnosphere Vacuum Bnaker �� Maaufact�er ��`7�.5 Siu � Modei Nimmber ��C�� Locatod At �''<_=�`�'✓F YC��7��,��.� Serial N�ber � ��.� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Initial Test DGClosed losed Tight Opened at Opened at esid Tightf Leal:ed ❑ nsid osid RP- /i� Dsid > I,eal;ed a / '� Dia nac opea o I,eal;ed o �� and Materials Used Test After DC-Closed Closed Tight o Opeaed at Opea�at __,osid Repair Tighi ❑ �sid __�sid R.P sid The above is certified to be we. Firm Name ��"ri� �m� Certifiod Tester J� r ry ,��jv(3,� Fitm Address l'B�C.2�7 C.�rr-.�t�,.'rt c T.��a�5'Cert. Testet No.�pDc�c��'o Ga� Date 1✓�- �./� Gauge # ��CC�"�O�'.�'�� llate Isst accuracy tested/l.� U White- Customer's Copy Yellow - City Copy PiNc-Testel''s Copy C�IECK ONE: IRRIGATION DOMESTIC FIftELINE v BACI{�'I.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE:�B�i_ eTr ��o G�.�''� �p.2 a�U �Gi�Dc,�i�rl ��O/� 'I3e bacl�low prevmtion assembly detailed below has baa tested aad maintain� � nq�� bv TNRCC regulauons and is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressure Principle � Pressure Vacui�Breaker lr7� Double Chcck Valvc ❑ Amnospherc Vacuum Breaker � l� Maaufacuaer �� Siu Model Ivumber �(Jf�(�/.� Located At �`�f�r1'ex�M �i��/� Seriai N�ber �„r`��a $� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAKER Double Check v alv�Assembly lst Check 2ad Checl: Relief Valve Air Inlet Check Valve Inidal Test DGClosed Closed Ti;ht Opeaed at Opeaed at osid Ti Leal:ed o Dsid nsid R.P��sid l� � I,�;� p Did not Opea o Leal:ed o �P� and Materials Used Test After DC-Closed Closed Tight o Opeaod at Opeaod at __flsid Repair Tight o �sid osid RP sid The above is cetified to be we. Firm Name ��'ri"� CG�r►�� _ Certified Testa ��r r�1 ��'r� FirmAddresspD�3I,?�7Gr�.aa�:nar�7��9 Cert TesterNo. ./��I�S�G�/��i Date , � (�suge # d�d�4�SC� llate last accuracy tested f0��/C��/y White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAN�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:�:Gcncc��L�'f�i� ��F� �' .,��' ,nnn�I/� ��/T The bacl,�low preveatioa assembly detailed below has beea tested and maintained as required by TNRCC re_sulations aad is cerdfied to be operating withia acceptable parameter5. TYPE OF ASSEMBLY c Reduced Pressvre Principle ❑ Pressure Vacu�Breaker ,�� Double Check Valve o Amiosphere Vacuum Brea�er � Zl Manufact�aer „�ll�Q 5 Siu Modei Ivumber �d�C�� Located At �S�I"�d�%YI��1,� Scrial N�ber L1 �Lf REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACWM BREAI�R Double Check Valve Assembly lst Check �nd Checi: Relief�alve Air Inlet Check Valve Iaitial Test DGClosed Closed Ti,pht Opeaed at Opened at nsid Tight Leal:ed o nsid osid RP-�psid �� p � �� Did not Open o Leal:ed o �P� aad Mataials Usod Test Aft,er DC-Closed Closed Tight a Opeaed at Opm�at _nsid Repair Tight ❑ �sid _,_osid R.P sid 'Ihe above is cud6od w be tirue. Firm Name��rYc o� _ Catifiod Testa � �r r �c�l UG�' Firm Address Pc 8�,1�7 C�ra dR�,��.r=�v a�r�Cat Taster Na P� � Date1 Gauge # L��U tflJ Sl.�� Date last accuracy tested ��/j�! White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:�Q4 p�C�t.r �aa��, �""��' L�.� �' �C!/(/� �t�Yl,v.�/�lt�tl�..��1�' The bacl�low preveation asscmbly detailed below has beea tested aad maiataincd as required by TNRCC reeulazions and is certified to be opera�ng withia acceptable paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle � Pressurc Vacuimm Breaker � Double Check Valve ❑ Amiosphere Vacuum Br�eaker � � // Maaufactzaer /�!�� Siu Model Ivumber �U� U � Locat�d At Y�°S�! I^uv/�'l�i�`# �� Serial N�ber ��., � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check Valve Assembly ist Check 2nd Chec�: Relief Valve Air Inlet Check Valve Inival Test DC-Closed Closed Ti�t Opeaed at Opened at _nsid Ti Leal:ed ❑ Dsid _nsid R.P��sid j� I,�;� a �' Did not Opea o Leal:ed o �� and Mataials Usod Test Aft,er DC-Closed Closed Tight o Openod at Opeaod at _�sid Repair Tighi � �sid osid R.P sid The above is cerafied to be true. Firm Name,/`1��rb �Uh►m• Cadfiod Tesca � G r r Zj J�/lU e?� Fitm Address/?�13/,2�,�Cr`r�cyB vi 3tG��'�''Cett. Testet No.Q�G"4Gr�G�y Date Gauge # Q �l1�/U�.�C� llate last accuracy tested�/� '" - White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE !� BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE:�G 4 t��'� ;. ��i c �.��/V C�,o,n�1�/�a�(�.�Q� The bacl�low preveation assembly detaile� below has baa tested and IDrZnCa�nCd as required by TNRCC regulanons and is cerdfied to be operating within ac,ceptable paramctcrs. TYPE OF ASSEMBLY e Reduced Pressvre Principle ❑ Pressvre Vacu�Brealcer -�� Doublc Check Valvc o Atmosphere Vacuum Breaker Maaufactiaer �� Siu � l� Model N�ber .� �° �i C� /�� Located At 'l��fSP 1r YUani.EY�i � � 7 Serial lvimmber (��_�_ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd C3ec1: Relief Valve Air Inlet Check Valve Inical Test DGClosed Closed Tight Opened at Opened at osid Ti Leal:ed 0 Dsid osid R.P�sid � �;� ❑ �� Did not Opea o Leal:ed o �P� aad Mataials Used Test After DC-Closed Closed Tight o Opeaed at Opeaed at �sid Rtpair Tight ❑ flsid _osid R.P sid The above is catifiod w be tcue. Firm Name��P�i^a CUn�t�► Certifiod Testa ��rT �C��U.� Firm Addrrss/�nR/.2!`7frY'r.n�v,:�rTac 7l�y'�Cat Tester No. Date Gauge # Cg'�!D�lV 51.�U llate last accuracy tested d (�'�f White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRBIGATION DOMESTIC FIRELINE BAC�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE��S1�7"1iA� ,��,�,�CJ/IO, Ce.'��7�/P�''SCl/� The bacl�low preveation assembly detailed below has beea tested aad maintained as required by TNRCC re_sulations and is cerdfied to be operating withia acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressvre Priaciple � Pressurc Vacu�Breaker �� Double Chcck Valve o Amiosphere Vacuum Breaker . , � fl Maaufact�aer �.�'►�'S Siu Modei Nimmber .��'L� C� � Locatod At �'��SGY Yv C�'1 �i� � ,� Seriai Nimiber �l G 1,�-��(�! REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Checic Valve Inival Test DGClosed Closed Ti,Qht Opeaed at Opened at esid Tight Leal:ed ❑ �sid _,nsid ��,psid a c �i� Did not Opea 0 Leai:ed � �� and Materials Used Test After DC-Closed Closed Tight ❑ Opeae�at Opmod at _�sid Repair Tight ❑ csid _osid RP sid The above is catifiod to be true. d�l�tr!> ' Firm Name �vh��!, Catifi�Testa'J��►'� S��GµC� /� Fi:m Addcessp4C3I2.7 Cs'r�9eva,i.-.�''x7C a�°1Cert. Testc No.�ppd��o�a�'1 Dat�� (�auge # (��0 yC1 _S7 5�' llate last accuracy tested D White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE V BACI�'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:� �J��,t1ie-�,�.c G�O�/; CT�a��d��,�,� �,SC�%� The bacl�tlow preveation asscmbly detailed below has beea testod aad maintained as require� by TNRCC regulauons and is cemfied to be opera�ng within acccptablc paramtters. TYPE OF ASSEMBLY e Reduced Pressure Principle � Pressure Vacu�Breaker •� Double Check Valve o Amiosphere Vacuum Breaker � ll Manufact�er /�� .� Siu Modei Ivumber ��(�a � Located At �"'��S eY �'Y�U 7�1,�� / � Serial Nimmber � �s l � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�C[TUM BREAI�R Double Check Yalve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inidal Test DGClosed losed Tight Opened at Opencd at osid Ti� ,r, Leal:ed ❑ nsid _nsid RP-�sid I,�;� o �� Did not Open o Leal:ed � �P� and Mataials Usod Test Aft,er DC-Closed Closed Tight o Opened at Opeaed at _�sid Repair Tight ❑ esid osid RP sid The above is certifiod to be ttue. Fi:m Name/�/C J`�'t� �dYJ,�'l. _ CertiSed Testa ��'YY i.� ,S�/!GY'�,� Firm AddrGu��1,6�(rr�a cw n c �7100�j Cert. Testa No. �O ' � Date� j (�auge # �'��'��/fJ��t� Date last accuracy tested / / � /� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRItIGATION DOMESTIC FIRELINE BACI{�'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE:�� i�Cc� �u't e �� (��/l0 C.o-b��l��cL, .SO%�`i The bac�low prevmtion assembly detailed below has baa tested aad ma�IILa�ned as requirod by TNRCC re¢uladons aad is certified to be operaung within acceptable paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle C Pressure Vacuimm Breaker s� Double Chxk Valve � Atmosphere Vacuum Breaker Maaufacturer /?`f1��5� Siu .-�/ j! Model N�bcr ��UU� Locatod At Ir)"SC►� 1SG Grm��G� �,Q Scrial Nimmber ��/1�.�._ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve Iniaal Test DGClosed Closed Tight ,2� Opeaed at Opened at esid Ti�t Leal:ed ❑ Dsid nsid RP-�sid `� �;� o � Y/ Did not Opea o Leal:ed J �Paire aad Materials Used Test After DC-Closed Closed?ight o Opeaed at Opeaed at __flsid Repair Tight ❑ osid __nsid RP sid The above is cetifiod to be true. Firm Name /v�� CG>1'I/''n-_ Cerdfied Testc°-�r r� .�e�Gc'i /� Firm Addr�i9�/ ,�7�",.r.�.U�n c�'�G/9��'i Cert. Testa No�i��rr S'4�CoS Date�� Gauge #(�� '(��CJ�':�� llate last accuracy tested/� ,�(.� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D. # LOCATION'OF SERVICE:i�'�c:�h� u�r. `��L�.�e C��D . ��c/��'� � C11� The bacl.�flow preveatioa assembly detailed below has beea tested aad ma�nta�n� � nq�� bv TNRCC re_Sulaaons and is c�ertified to be operating withia acceptable paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle ❑ Pressurc Vacu�Break�er .� Double Check Valve � Atmosphere Vacuum Breaker Maaufactsaer �_� S Siu � � Modei Number Z �[�4� Locat�d At }"!'S�r r[ao� ��G � oZ � Serial Iv�ber ,Z-- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check v alve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed Closed Ti;ht o Opened at Opened at nsid Tight ❑ Leal:ed o nsid osid R.P-_psid �;� Did not Opea o Leal:ed o �P� and Matarials c �G�C�'!G' Used Test After DGClosed Closed Tight Opmed at Opeaed at �sid Repair Ti I�<l osid __osid RP sid � � The above is cctifiod to be true. Firm Name��'1`�'r) _�D,��! Certified Tester �.J G �''�' � �C�f,l�C._ Firm Address4�l�/z�7Gr�r,,o��r;.�:� �x��G�r1�Cat Tester No.� . Date` Gauge # b �'C��("�IS�("� Date last accuracy tested `�� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK O1dE: IRRIGATION DOMESTIC FIRELINE ✓ BACT�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOI3 OF SERVICE: .c•n�� G�ri' �o�,� ll 7.�� The bacl�low preveation asscmbly detaile� bclow has bxn iested sad maintain� � nq�� bv INRCC regulations and is cerd5ed to be operating within acr,eptable parameters. TYPE OF ASSEMBLY C Reduced Pressurc Principlc C Pressure Vacu�Breaker .� Double Chxk Valve ❑ Amiosphere Vacuum Breal:er �J � �l Maaufarnaer '�/jI C-'S _ Siu Modei N�ber '?�'-�� Locaud At �r��r �"�C�I��- Serial Ni�ber � � � �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Check 2nd Checl: Relief Valv� Air Inlet Checic Valve Initial Test DGClosed Closed Ti;ht Opeaed at Opened at osid Tight= Leal: o osid nsid h Q RP-�/c� Dsid ; � �� p Did not Open o Leal:ed � �P� and Materials Used Test After DC-Closed Closed Tight o Opeacd at Opeaed at osid Repair Tight ❑ �sid osid RP sid The above is certifiod to be ttue. Firm Name^ r 1"rD ��,�'f/�1� Catifi�Testa . �P lr y u Si,fZUo K Firm Address/�O� /,�'7�rra�,�,e Cert. Testa No.B�'Oa4 Date 7"� ��o9q Gauge # 0$C�� '{S� llate last accuracy tested�L'� %Co� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRIZIGATION DOMESTIC FIRELINE � BACKFT.OW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:��re�u�v `t�� ;QaI/�a �c;0��'II��C��l The bacl.�tlow prevmtion asscmbly detailed below has beea testcd aad maintained as required by TNRCC rcguladons and is certified to bc operating within acceptablc paramcters. TYPE OF ASSEMBLY e Reduced Pressurc Principle ❑ Pressure Vacuimm Brealcer �✓ Double Check Valve a Atmosphere Vacuum Breal:er ,� � �� Manufacnirer /?`_l�� Siu Model Ivumber � ��/.7 Located At ��'��'I��(?l�'l1✓�e�'`��.3 Serial Nimmber ��/ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Double Check Valve Assembly lst Check 2nd Checi: Relief Valve 4ir Inlet Check Vaive Ininal Test DGClosed Closed Ti;ht Opened at Opeaed at osid Tight,� ,� Leal:ed o nsid nsid R.P-�sid � r � I,�;� p Did not Opea O Leal:ed � �P� and Materials Usod Test After DGClosed Closed Tight o Opeacd at Opeaed at nsid Repair Tight ❑ �sid osid RP sid The above is catified to be true. Firm Name�GTY'o C G/��19. _ Catifiad Testa �_� sU/l� Firm Address D�«.7G-Y GI/��C Cert. Testa No.��4 Date�1L�� T 7(�U�� Gauge # 0�1f� Sb llate last accuracy tested /d /U � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE � BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT rraME OF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE;�p.�,��,�1j. L��g ��b�(�-��'�s� The bacl.�tlow preveation asscmbly detailed below has beea tested sad ma�niain� � nq�� by TNRCC regulauons aad is cemfied to be operating within accrptablc parametrrs. TYPE OF ASSEMBLY ❑ Rcduced Pressure Principle C Pressurc Vacui�Breaker .,e,P� Doublc Chxk Valve o Atmosphcrc Vacuum Breal:er ,� �l Manufact�aer ��n 5" Siu -� Model N�ber ��%% �?G� Locaud At 1'�l ��Y ��G'�i�lS��y Serial N�ber �i�� .,_ REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Cherk Valve Assembly lst Check 2,nd Checl: Reiief Valve Air Inlet Check Valve Inirial Test DGClosed losed Ti;ht Opened at Opened at osid Tight Lcal:ed ❑ nsid osid R.P-�sid �� I,�;� a Did not Opea o Leaked � �P� and Materials Used Test Aft,er DC-Closed Closed Tight o Opeaed at Opeaed at �sid Repair Tight a nsid osid RP sid The above is certified to be t:ue. � / Fum Name /yIG 7"rD Cu�►�. Catifiod Tessta J e� _Sr�'l40� Firm Address l°D/3/ 7 C��v.i�G Cat Tester No�� Date��- � �' 7� ��oqg (�auge # O-g'D`I 4gS C� llate last accuracy tested �!� lJU 1/� White - Customer's Copy Yellow - City Copy Pink -Tester's Copy C�IECK O1dE: IRRIGATION DOMESTIC FIRELINE BACT�'LOW PREVENTION ASSEIVIBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE:,�,4c�c� �� 1,��'��,��%JJ� C�;�n�/�t!�-/,��U�S�' �— The bacl�low prevmtion asscmbly detaile� below has beea iested and ma�ntain� � nq�� bv TNRCC regulations and is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressurc Principle C Pressure Vacu�Breaker „Yr pouble Check VaIve o Atmosphere Vacuum Breal:er Maaufactsaer �ivL!'':�' Siu � �� Modei Ivumber �� Located At �1>�r �'o L��f�15�,',�'j� Seriai Nimmber /%,r��C) �7 � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check V alve Assembly lst Check 2ad Checl: Rei;ef r a�� Air Inlet Check Valve Inirial Tat DGClosed Closed Ti�t Opcaed at Opeaed at esid Ti�t Leal:ed o nsid nsid RP- �o.�Dsid I,�;� o •�' � Did not Opea o Leal:ed � �P� and Mataials Used Test After DC-Closed Closed Ti¢ht o Opened at Opeaed at __�sid Repair Tight ❑ osid osid RP sid The above is cerdfiod to be t:ue. Firm Name ,/ "[.r�'Y'l� ( _d�nL� C«tifiod Testa �,�'r u ��ir�n.� Firm Address 1°0�.21�7G� ✓�' t Cert. Tester No. Date r ��099 Gauge # O�'O�L(�g�� Date last accuracy tested �� !",✓C�� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: � IRRIGATION DOMESTIC FIRELINE � BACIQ�'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT rr,�oF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE;� �nc��.1��'a'N. C'a��t'I�i�l v��/� The bacl�low preveation assembly detaile� below has beea testod aad mainL�Cd as required bv TNRCC regularions aad is cerdfied w be opera�ng within acceptable parameters. TYPE OF ASSEMBLY C Raiuced Pressure Priaciple � Pressure Vacuimm Breaker 0� Double Check Valve o Auaosphere Vacuum Breaker Maaufactiaer i'l``�'I�'J` Siu � 1� Model Ivi�ber ��l/� Located At I'�?`SG'Y YOO/1t�/y`�� Scrial Nimmber �� g,�- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Cherk v alve Assembly lst Check �nd Cbeci: Relief Valve Air Inlet Check Valve Inival Tast DGClosed Closed Ti,ght Opened at Opened at nsid Ti�t Leal:ed o osid _osid RP-�psid � Leal;ed ❑ �� Did not Opea o L,eai►ed o �P� aad Mataials Usod Test ARet DC-Closed Closed Tight o ppeaod at Opeaed at nsid � Repair Tight a �sid osid R.P sid The above is cerafied to be�ue. Firm Name �C;��o �l�1�. Cerafied Tester ,�Gr d'y.��f'lao �` Firm Address�l��1 ��'�a��'=�''�'�'Cert. TGstcr NoC �'�� Date cg� #G��'6 yo&',�� Date last accuracy tested� f� J White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINB � BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE:�'�c� nr�, �• ,�,�-�iv _ � ��%;?/1/l/, �'�-�;��f�/Z°' , 75��{j� The bacl��low preveation asscmbly detailod below has baa tested aad maintain� � nq� bv 'I'NRCC regulauons aad is certified to be operating within acceptable paramtters. TYPE OF ASSEMBLY e Reduced Pressvrc Principle ❑ Pressure Vacui�Breaker � Double Check Valve o Atmosphere Vacuum Breal:er Maaufact�uer ,��,G'S Siu �/� Model Number ��r'�� 'i Located At ��/,�S��Y �i��ni��c, �...�� Serial N�ber 11�C�/� �C7 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check v alve Assembly lst Check 2ad C3ecl: Relief Valv� Air Inlet Check Valve Inival Test DGClosed Closed Ti�t Opened at Opeaed at osid Ti�t Lcal:cd� 0 �sid osid R.P-�sid Leal;cd O / " Did noi Opea O I,eaked O �P� and Mataials Usod Test After DC-Closed Closed Tight a Opened at Opeaod at __�sid Repair Tight ❑ �sid _,_osid RP sid 'Ihe above is cctifiod to be true. Firm Naau��'�`"r'� ( /f��'!�'�1. Certifiod Testa � � �`��; �fiLC�� Firm Addressp��_ � T �D�JPCert. Testa No.��1'Ca� 6 Date l�/� c3auge # (�� f��G llate last accuracy tested 1� � r � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy r C�iECK ONE: IRRIGATION DOMESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE:�e G c°��s�u fi�a � � (y 'l� e r�n� ��7' 6 % � The bacl�low preveation assembly detailod below has beea tesced aad ma�rtain� � nq� bv TNRCC re¢ulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY � Reduced Pressure Principle C Pressurc Vacu�Breaker Double Check Valve ❑ Atmosphere Vacuum Breaka ,�/ �j� Maaufactiaer /`7'��%.� Siu Model Number � ��J � Located At Y/�S�'Y �"Oc� ��`��p � Serial N�ber Q� l 5�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doubie Check v alve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Va1ve Inival Test DGClosed Closed Tight �'S Opeaed at Opeaed at nsid Tigi�t Leal:ed o _�sid osid �_1y� DSld �� I,�;� o Did not Opea o Leal:e� O �P� and Mataials Used Test ARet DC-Closed Closed Tight o Opeaed at Opeaod at __nsid Repair Tight o Dsid osid RP sid The above is catifiod to be true. Firm Name �'y r0 ( � y/1 m Certifiad Testa��r Y7 �C�'�c�G� Firm Address�81��?'Yd�[��11iY1��GUYl Cert. TasterNo.� �f" Date��- � Gauge # ��'�L7��"� llate last accuracy tested (� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy � C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACI�LOW PREVENTION ASSEMBLY TES'T AND MAIIV'I'ENANCE REPOR? N.�ME oF Pws: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE:��T ,�L ,�c � 0/1� (��n�a lI�� 7S�'J/� The bacl�low prevention asscmbly detailed below has been testod aad maintain� � nq� bv TNRCC reguladons aad is certified to be opaating within acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Pressure Vacu�Breaker � Double Check Valve o Am�osphere Vacuum Breaker ,( Maaufactiaer �lY!�S Siu � Model Ivumber :�/��L�,� Located At Yi`,�G•r y�vOyri,[�✓�,�� Serial Nimmber Q ��2 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Cbeck Valve Assembly lst Checic 2nd Checi: Relief Valve Air Inlet Check Vaive Inidal Test DGClosed Closod Ti,ght Optaed at Opened at nsid Ti�t Leal:ed o �sid _osid RP-�sid �� I,eal;ed o Did not Opea o I,eal:ed o �P� and Materials Usod Test Afttr DC-Closed Closod Tight o Opeaed at Opeaod ac __nsid Repair Tight a Dsid _osid RP sid The above is ceRifiod to be We. Firm Name ��J`r� Cc/�x�• Certifiod Tester �.I �YY1a �S��ac✓�! Fiim AddressPdL�f.z��L�r'�n.t„=i��7�op�Cert.TtsLet No.�PDrY1�Gl'��Date� Gauge # C5�lJ�D�S C1 Date last accuracy tested J(?�Q White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINB � BACI4Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE• �� ' ,��x��r�e C�.11` R��,g1/.t�� ?�c��9 The bacl�low prevtntion assembly detailed below has beea tested aad maintained as required by TNRCC reaulations aad is certified to be operating within acceptable paramtters. TYPE OF ASSEMBLY e Reduced Pressure Principle C Pressure Vacuimi Breaker ,� Double Check Valve ❑ Amaosphere Vacuum Breaker � 1l Maaufact�er �.�s��3� Siu Modei Iv�ber ��GlS� Locaud At �'/rS�r�'Oan-t�� S��ba C� �3 y� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Chec�: Relief Valve Air Inlet Checic Valve Initial Test DC•Closed Closed Ti,Pht Opened at Opened at osid Tight Leal:ed � osid _osid RP-�sid I, � �;� ❑ D i d noc O pea o L e a l:e d J �P� aad Materials Used Test After DC-Closed Closed Tight o Opened at Opeaed at __nsid Repair Tight o osid _._nsid RP sid The above is catifiod to be tcue. Firm Na�e /''l��'�" Catifiad Teste �� Y ' � � Firm Address/aiY'�/��'' �� f Cert. Tester No.,�7�d�0�'��4 Date I [ Gauge # (� �OS�G°�'S� Date last accuracy tested �U White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACT�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE/P�i°�`��;��°L�� o��U �y�.�✓�1�1��J�CT�� The bacl�low preveation assembly detaile� below has beea tested aad maintain� � nq� bv T'NRCC regulazions and is cerdfied to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressure Principle ❑ Pressur�Vacuimm Breaker � Double Check Valve o Amnosphere Vacuum Bnal:er � 1C Manufact�er ��2!�,S Siu Model Number �GY�6� Locaud At �yls'z a''1�C3t)lYl�� '� Serial Nimmber ��01��0 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valv�Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DC-Closed Closed Tight Opeaed at Opened at _osid Tighi � Leal:ed o �sid _osid R.P-�sid I,�;� ❑ /`� D i d not Opea o L,e a l c e d � �P� and Materials Used Test After DC•Closed Closed Tight o Openod at Opeaod at �sid Repair Tight ❑ osid __nsid RP sid The above is cerafiod to be true. ' ..��r r�t .�cf1c`�G��` Firm Name� �i''� ��'j'1 _ Catifiod Testa Fitm Addt+es.�e �r' r c c 0�j�' Cert. Tester No.� Date�� Gauge # CUi�'(�,�Ct�'�'J� Date last accuracy tested �a �'� White - Customer's Copy Yellow - City Copy PiNc-Testel''s COpy C�iECK ONE: IRftIGATION DOMESTIC FIRELINE � BACIQ�Z�OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE�'f 4��tC y�c,� GL��r �n:�D�j!- C'aa�s�/�il�� D 1� The bacl�low prevmtion assembly detailed below has beea tested aad maintain� � nq� bv TT�IRCC reguladons and is cerdfied to bc operating within acceptable paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle C Pressvre Vacu�mm Breaker � Double Check Valve o Atmosphere Vacuum Breal:er � 1� Maaufactsaer ��'I_G�S Siu Modei Iv�ber �Od� Locaud At �'iS�/'I"�o�'115�' �L' Serial Nimmber GUD l.S�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubk Check Valve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Valve Initial Test DGClosed Closed Tight o Opeaed at Opeaed at osid Ti�i ❑ Leal:ed o osid osid R.P-_psid L,�;� Did not Opea o Leai►ed J �� e�/�c�� a�nc� Materials ��'�� ' Used �~r��-5 Test After DC-Closed Closed Tight Opened at Opeaod at _�sid Repair Tight y� ,�� esid _nsid R.P ' U sid The above is certified to be true. Firm Name r��rv C��Y1,� Ce�tifiied Testa � �'1'u_ �� Fi�Address� ��/° aay.:�� Txc��4�� Cat Te�No��°�4�5?GG,S' Date/a '�i� (3auge # �`1�6`7'D�SG' llate last accuracy tested�c� c� � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE9Pp9r.r►c�r �c,� �,��o2dQ.��,,Q�?�.. �S�'J� The bacl�low prevmtion asscmbly detailed below has beea tested aad maintained as required by TNRCC reguladons and is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Reduced Pressnre Principle C Pressure Vacu�Breaker Y Double Check Valvc ❑ Amiosphere Vacuum Breal:er � �C Maaufacuaer , � Siu Model Number �I�[�Q,./�i Located At �'��7r I"Q�a7Yl.�i��7 Scrial N�ber �� .�/�/� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACWM BREAI�R Double Check Valv�Assembly lst Check 2ad Checl: Relief Valve Air Inlet Check Valve Ininal Test DGClosed Closed Ti;ht Opened at Opeaed at osid Tight Leal:ed ❑ �sid _nsid RP-�sid / � I,�;� ❑ �`` Did not Opea o Leal:ed o �P� and Materials Used Test Afttt DC-Closed Closed Tight o Opeaed at Opeaod at _�sid Repair Tighi o nsid _,_,osid RP sid The above is certifiod to be true. Firm Name /'l n�i�'� �OIY�d�t� Certifiod Tester ��Y f ' Firm Address�Q�I��G ru-ri-�••'Kc/�7�Q��Cert. Teste No�d�ODa8lo�9 Date (�auge # Q��'C��fD�S d llate Isst accuracy tested/(� d White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE;CJG�c:�a e�ti�tn�s�G �.•�:: �i G/�� C'��e�/,�� SO r Cj'� 'Ibe bacl�low prevmtion asscmbly detailed below has beea tested aad maintained as required by TNRCC regularions aad is cerdfied to be operating withia acceptable paramcters. TYPE OF ASSEMBLY � Reduced Pressure Principle � Pressur�Vacu�Breaker ,,e� Double Check VaIve ❑ Amoosphere Vacuum Bnal:er � �( Maaufactiaer /!"1�' Sr Siu Modei Number �l)G�.� Located At ✓`r'�S��'�r'vt�'Y► �,��S� scrial N�bcr �U� %��D REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check v alve Assembly lst C3eck 2nd Checl: Relief Valve Air Inlet Check Va1ve Inival Test DGClosed Closed Ti;ht Opeaed at Opened at osid Tight Leal:ed � o �Dsid _,osid RP-�sid � uai;ed o / Dia noc opea o I.eal:ed a �P� and Mataials Used Test ARer DC-Closed Closed Tight o Opeaed at Opea�at _�sid Repair Tight o osid __osid RP sid The above is cerdfied to be true. Firm Nam��G.��"�� ✓�� Certified Testc �e rr z'1 �/�/��a �: Firm Address��'�.��7�arrw!�.A� J�,7G�G'�y� Cert. Tester No�PO�le�S% Date,��sL� Gauge # C�SrC��'S�F7 llate last accuracy tested ,/ � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE V BACI4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATTON OF SERVICE:�P�P cu �u¢��L�/�e �� C=�bo.�.�,1/G� �Sd �9 The bacl.�tlow prevmtion assembly detailod below has beea tested and maintain� � nq� bv TNRCC reguladons and is cerdfied to be operating within acceptablc paramcters. TYPE OF ASSEMBLY C Reduced Pressure Principle � Pressvre Vacuimm Breaker � Double Check Valve o Atmosphere Vacuum Bnaker �� Manufact�er _�/I'1 eS Siu Modei Iv�ber .�D(! �I� Located At b'l SPY 1'QcrmD�G`'��' Scrial Nimmber ��/ S2 1 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Cherk ?ad Checl: Relief Valve Air Inlet Checic Valve Initial Test DC-Closed Closed Ti;ht Opeaed at Opeaed at _nsid Tight Leal:ed 0 �sid nsid �- . / S�d 1,� �;� o Dia noc Open o Leal:ed � �P� aad Mataials Used Test After DC-Closed Closed Tight o Opeaed at Opmed at _nsid Repair Tight ❑ osid _osid RP sid The above is catified to be true. Firm Name/v(�'�rr� �G�,m,_ CertiSad Tesca P Y Y�1 r��cS� ,� Firm Address� " ` ��9 Cert Testc No.�PO4��61v �l Date� Gauge # ��f llate last accuracy tested�D/��3 � White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECR ONE: IR.RIGATION DOMESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPORT NAME OF PwS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE��teu �U��i!.��c� ��/V��o./J�,�1, . �j'�19 The bacl�low preveatioa assembly detailed below has beea tested aad r�ta�ned as require� by TNRCC re_euladons and is certified to be opera�ng withia acceptablc paramcters. TYPE OF ASSEMBLY e Raiuced Pressvre Principle C Pressure Vacu�Breaker � Doubl�Check Valve o Atmosphere Vacuum Breaker „�l Manufact�uer Siu �C Model Number ��d,u Locaced At ?f G'��Y Y'ct�m�1,�� s��N�ba 0�� / y REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DGClosed Closed Ti,Pht Opened at Opened at nsid Tighi Leal:ed� �/ 0 nsid _osid RP-�sid 1 I I,�;� ❑ Did not Opea o Leal►ed o �P� aad Mataials Usod Test ARer DC-Closed Closed Tight o ppened at Opeaod at �sid Repair Tight o �sid _,_osid RP sid The above is certified to be true. Firm Na��L'7 r��a�iy?� Cetifiod Testa �C' +r Y'�-I �efi� 0 � FirmAddr+ess/�8�1�76-r��o,�r�.�i,v��6o� Cert. TGsterNo. Do Date� Gauge # _(��CS�G�,i r� Date last accuracy tested� " White - Customer's Copy Yellow - City Copy Pink-TesteCs Copy C�iBCK ONE: IRItIGATION DOMESTIC FIRELINE �/ BACI�'LOW PREYENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATTON OF SERVICE�'4P.�iCu, �4 y.l�L�e ��d'� C�,�,�.-/��,�'r� ,��' 'Ibe bacictlow preveation assembly decailed below has beea tested aad maintained as required by TNRCC regulauons and is cerdfied to be operaung withia acceptable paramcters. TYPE OF ASSEMBLY C Rtduced Pressvre Principle e Pressure Vacu�Bn,aker � Double Check Valve ❑ Amiospherc Vacuum Breal:er � l� Manufactsaer �' Siu Modei Iv�ber ;2�OC3� Locaud At '�r�SC'a' Y0�`�t�� Serial N�ber � ��'.� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check Yalve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Checic Valve Inival Test DGClosed Closed Ti�ht Opened at Opeaed at _osid Tight f Leal:ed o nsid nsid R.P- ��sid I,�;� o �'$ Did not Opea � Leal:ed � �P� aad Mataials Used Test ARer DC-Closed Closed Tight o Opeaed at Opeaed at __.nsid Repair Tighi ❑ flsid �osid RP sid The above is cerrified to be tiue. Fiim Name��I�t✓'� �m_n► Certifiod Tester �� LM� � Firm Address�,g/��7G'�'c:m,<tr��t?�j�%Cat Tester No d� Date � l (�auge # L3�C�yQ fj Sd llate last accuracy tested�d jO ' White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE �/ BACT�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE:�'eaP�u ;h,�. >'.�r� �.�' �r�,�Z��Cch�.�I/�l ��G'�� The bacictlow preveation asscmbly decailod below has beea tested aad ma�nta�n� � nq�� bv TNRCC regulauons and is certified to be operating withia acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Pressurc Vacuimi Breaker � Double Chcck Valve o Atmosphere Vacuum Breaker /t' Maaufactiaer ��5� Siu ,� Model Number �f�fJ�O � Locaud At d��'^�GY)"Gc7�'1'1�� Serial N�ber aC�C�/.�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DGClosed Closed Ti,Pht Opeaed at Opeaed at nsid Tight �' Leal:ed o esid osid �-��S�a 2l I,eal;ed a � Dia noc Opea o L,eal:ed o �P� aad Materials Used Test ARer DC-Closed Closed Tight o ppeaed at Openod at �sid Repair Tight O �sid _nsid RP sid The above is certified to be true. Fum Name��I'Y�o C�sr►m Certifi�Testa � � r Y'�i ,J�U n. � Firm Address�'��'•��7(,asc�e�sh_Cf"��Cert. Testa No��XGr,�,�' Date��(;�� Gauge #��C��f�� llate last accuracy tested� � White- Customer's Copy Yellow - City Copy Pink -Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT' x.�ME OF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE��,��, ��.�e rr 0/U, ('t��,� � CI�l The bacl�low preveation asscmbly detailed below has beea tested aad maintained as required bv TNRCC reguladons and is certified to be operating witbin acceptablc paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle � Pressure Vacu�Breaker � Double Chxk Valvc ❑ Atmosphere Vacuum Breaker � � r Maaufacnaer ��.S� Siu Model N�ber �� Locaud At Y`l�C a� �'D�j�� -�G�� s��N�ba �vc��y7 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Check ?nd Checl: Relief Valve Air Inlet Check Valve Initial Test DGClosed Closed Ti,Qht Opeaed at Opened at _nsid Tight Leal:ed o nsid osid �_ l,_7�S;d 9 � o G `� Dia nac open o L,eal;ed o �P� and Mataials Usod Test After DC-Closed Closed Tight o Opened at Open�at __osid Repair Tighi a csid _osid RP sid 'I�e above is certified to be true. ' �e-Y' Y Ul ��1 Firm Name�I��r'r� �i'j.ar». Cectified Tester � d�3� Firm AddressP�.$i:1G�7Cf,�r.�uir�c, ,Tx��aO�'i Cat Tester No.�I��fKfB(��i' Date,•2 � Gauge # �S�C�S�G�`G�.�G`� llate last accuracy tested �C� E'� 1 White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACT�7.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? rr�oF Pws: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE;�L�.��-�U b��.�� 'i�1 C�,,�,��,J�� The bacl�low prevtntion asscmbly detailed below has beea tested aad maiatained as required by TNRCC regulanons aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY e Reduced Pressure Principle ❑ Pressurc Vacu�Brealcer .� Double Check Valve o Atmosphere Vacuum Breaker ,� d/ Maaufact�er ��' Siu .f, Model Number .,�l�lJ�`)� �ua at �fi�S�r�'�m,�/�'��'� s«��N�ba �eal�l�' REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valv�Assembly lst Check 2nd Checl: Relief�alve Air Inlet Check Valve Inival Test DGClosed Closed Ti,Pht Opened at Opened at osid Tight Leal:ed 0 �sid nsid RP-�psid � � I,�;� p Did not Opea o Leal:ed � �P� aad Materials Usod Test ARer DC-Closed Closod Tight o ppeaed at Opmed at __nsid Repair Tight o �sid osid R.P sid The above is certified to be tcue. Firm Name�-G'�Y� �[��'l�-i Certified Testa � 1 " �"Y'`/ �SC��`i��r� _,.__— Firm Address��B/,��7;�r�r.�i,. T�D�'� Cert. Testet No.�/�al�O.�G( � Date (3auge # ��S�J llate last accuracy tested/�J' `(� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy