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2014_1008 C�IBCK ONE: IItRIGATION�_ DOMESTIC FIBELINB BACKFLOW PREVENTION ASSEN�LY TEST AND MAIIV I'ENANCE REPORT NAME OF PWS: /�i�rv � (!��,1��,� PWS I.D. # LOCATTON OF SERVICE: � �S . /-1cR�rl"L � The bacl�low preveatioa asscmbly detailed below has been tested aad maintaiaed as required by TNRCC regulanons and is cati5ed to be operating withia acecptable paramesers. TYPE OF ASSEMBLY ❑ Reduced Pressure Principle � Pressure Vacuum Breaker �- Double Check Valve ❑ Amoosphere Vacuum Breaker Maaufacturez .��<�,,,,(1 Siu � r � Model Number �� Located At �• ��o -�- N, �L7h� �'� s��N�ba �j c��'� I REDUCED PRESSURE PRINCTPLE ASSEMBLY PRESSURE VACITfJM BREAKER Doubie Check�%alve Assembly lst Check Z•�j Znd Checl: 2.� �ef Valv� Air Inlet Check Valve Inival Test DGClosed Closed Ti;ht � Opeaed at Opeaed at _osid r_ Ti�i � Leal:cd o nsid _osid , G� RP-_,Psid L e a l;e d o D i d no t O pen o I,e a k e d o �P� and Materials Used 7est After DC•Closed Closed Tight O Opeaed at Opcaed at _�sid Repair Tight ❑ _nsid osid RP sid 1be above is certifiod to be true. Firm Name L�' Certified Testa ��'e U i U f�i i ��-/ Firm Address � �r��Y! l�V l.✓✓ Cat Testa Na ��n,��ate 1 �� . ,� _ k� Gauge # � �'j(`�j� - llate last accuracy tested � � White -Customer's Copy Yellow - City Copy Pink-Tester's Copy .. .,: . ... . . . . . .. . . . . CHSCK ONE: IRRIGATION c/ DOMESTIC FIRELINE BACI�LOW PREVENTION ASSFNIBLY TEST AND MAINI'ENANCE REPORT NAME OF PWS: —r w n.1 �r'l�-F�' CI E'/Y1�Tt�ri-� PWS I.D.# LOCATION OF SERVICE: ' �� l�E'-Q'��Z ��, The bacl�low preveation asscmbly decailed below has beea tested and maintaiaed as required by TNRCC reguladons and is cerd5ed to be operating withia acceptable parametars. TYPE OF ASS�LY ❑ Reduced Pressure Principle 0 Pressure Vacu�Breaktr � Double Check Valve o Atmosphere Vacuum Breaker Manufacturer �e� Size Z� � Model Number �� Located At � �r . o u��+e�� Serial N�ber C'� � �l_)T '�I`t' REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doubie Check Valve Assembly lst Check �.5 Znd Checl: Z� �ef Valv� :alir Inlet Check Valve Inidal Test DGClosed Clos�d Ti;ht � Opeaed at Opened at _nsid Ti�t '� Leal:ed o �sid _osid �aLjS RP-_psid Leal:ed ❑ Did not Opcn O I,eal:ed O �P� aad Materials Used Test After DC-Closed Closed Tight O Opened at Opened at _nsid Repair Tight o nsid _nsid RP sid The above is certifiod to be true. Firm Name��()<_)k�� y 5� Catified Testa l J�U 1� t r Xl 1 t�1 Firm Address � �-+�✓ Cat Tester No. �� Date r � Gauge # �eJ�QQ� llate last accuracy tested � White-Customer's Copy - Yellow - City Copy Pink-Tester's Copy 1 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) � �P Q�� MAILING ADDRESS: (��rq fi �� CONTACT PERSON/PHONE: U , 1 Z�4 - `�g� ^ d40 LOCATION OF SERVICE: (S�S N i P1t L i oW N T6�L ��1- 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 i IReduced Pressure Principle-Detector �Double Check Valve ��Double Check-Detector ❑PressureVacuumBreaker � ISpill-Resistant Pressure Vacuum Breaker �r Manufacturer "C�LC� Model Number ��O Size � Located At �('01��OT -�e-h'D0� ��'�'�`�`•/G�� Serial Numberrl �� I `�" 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 ��l psid Opened at Opened at Fleld at Initial Test Closed Tightjd ClosedTight �)1� psid psid psid Leakedl I Leaked❑ Did not open I Did not open f : Leaked l Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight f �� Closed Tight�.i psid psid psid Test gauge used: Make/Modell.-D/nfJrQf O �V� �b�� le SN:2�� Date Tested for Accuracy: �� /� , Remarks: Tbe above is certified to be true at the time of testing. �-. FirmName �p��L�- "l"S� Firm Address �� l�,Jl� �Y !��' Certified Tester(pr:nt) I� f � Certified Tester(signature) � Firm Phone# �� `T l��v Cert.Tester No.��7s� Date d � ��J * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-"City Copy Ye11ow-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: ��3 ��A�GI�- C-�Q �� \1C CONTACT PERSON/PHONE:LOu 5 PeC�sS �l�{ - �F�'r(o-SZ7�f b LOCATION OF SERVICE: ►�Sr N• 8 ,owiU �b,� �'(�. 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 I 'Reduced Pressure Principle-Detector �bouble Check Valve I J Double Check-Detector -7PressureVacuumBreaker f-ISpill-Resistant Pressure Vacuum Breaker Manufacturer �� r-cjJCO Model Number Size � Located At �2d� � S�►�d� uf>Qi/�� Serial Number � �d�� 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 ��c/ psid Opened at Opened at Held at Initial Test Closed TightDQ Closed Tight �1' psid psid psid Leaked� I Leaked 1 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 C1 ClosedTight I I psid psid psid Test gauge used: Make/Model��"0.C-d `�Q'"ZOD--T1� SN: Z�$OC� Date Tested for Accuracy: �i�I�f I I� Remarks: The above is certified to be true at the time of testing. FirmName��I ��S� Firm Address ('�� Wran. C,�✓ Certified Tester(print) �� Q Certified Tester(signature) �/ !/ ,/,� �J �y, 7 g Firm Phone# ��T �`T 5` �$�'f� 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