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2015_0315 C�IECK ONE: IftRIGATION DOMESTIC FIRELINE� r BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT' i NAME OF PWS: CITY OF COPPELL Pws I.D. # LOCATION OF SERVICE: ��J L� P•C �400 S• M4i �C ��. o�e� ��1. • The bacl�low prevmtion assembly detailed below has beea tested and maintained as required by TNRCC reguladons and is cectifiai to be operating within acceptable parameters. TYPE OF ASSEMBLY C/ Rcduced Pressurc Principlc ❑ Pressure Vacuimm Breaker � Double Chcck Valvc o Atmosphere Vacuum Breaker , Maaufact�er �8�n Siu � ��.�` Model Number �� Locatcd At �`S�(� ?j Serial Ni�ber �S 7 to ��l REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed / Closed Tight Opened at Opened at _csid Tight [� Leal:ed o osid _nsid �P�S x.�- l�s�a 2 .� I,eal;od o Did not Opea o L,eal:ed 0 �P� and Mataials Used Test Aft,er DC•Closed Closed Tight o Opeaed at Opmcd at �sid Rcpair Ti,Qht ❑ _nsid _nsid RP sid The above is certified to be tive. � Firm Name�e�`� �\c'� CeRified Testa��C�°•6 (�(l�C I�,��" Fi:m Address 1��h C o�t c S�c• Cert. Tester No.`�OO IyQl7 Date � D��aS �,� -,s��. � 3/l�/IS c�auge # 33\-1 $ llate last accuracy tested a� White- Customer's Copy Yellow - City Copy Pink -Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE� � BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? � NANIE OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '�J � PC t400 S. N1� �C ��v�. � The bacl�low prevention assembly detailed below has beea tcstod aad fia�*+��as �required bv TNRCC regulations aad is cerdfied to be operating within acceptable parameters. TYPE OF ASSEMBLY ` Reduced Pressurc Priaciple e Pressurc Vacuimm Breaker �� Double Chcck VaIvc o Amiosphere Vacuum Breaker Maaufacuaer ��C n Siu I `�-�-`� Model Number � � Located At �SL(� � Serial N�ber �`-'� � Lo��-- REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly ist Check 2ad Checl: Relief Valve Air Inlet Check Valve Inival Test DC•Closed Closed Ti�t Opeaed at Opened at �sid Ti�t Lcal:ed o nsid __osid RP-�sid ��S �;� o ` � � Did not Opea o Leal:ed o �P� aad Mataials Used Test After DC•Closed Closed Ti,Qht o Opeaed at Opmed at �nsid Repair Tight o �sid osid RP sid The above is cerafied to be true. Firm Name Teke�.\ ��c'� Cectified Testa��C�0•6 I �1�C I�,��`' Firm Add�ess �q�h C o�t c S�c• Cert. Testa No.`�0 01 y 417 Date�� D��.s �-� �5��. � 3�j�� Gauge # 331-1 $ llate lsst accuracy tested_ a� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IR.RIGATION DOMESTIC FIRELINE� � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? � NAIv�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '�J `a PC �St00 S• 1� �� Q\v17. \ The bacl�low prevmtion assembly decailed below has beea tested aad maiatain�as �required bv TNRCC reguladons and is certified to be operating withia acr.eptable paramcters. TYPE OF ASSEMBLY e Rcduccd Pressurc Priaciplc � Pressurc Vacu�Breaker � Double Chcck Valve o Atmosphere Vacuum Bresker Manufact�aer �� Siu ` +�•� Model Ivumber � ��/ Located At �`SQ� �--j Sezial N�ber �� 3� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Cherk 2nd Checl: Relief Valve Air Inlet Check Va1ve Initial Test DGClosed Closed Ti�t ❑ ened at Opened at vsid Tight C] Lcal:ed osid _nsid R.1\ �"-Psid Leal;od Did not Open O Lealce� o �P� aad Mataials Used Test ARer DC-Closed Closed Tight o Opeaed at Opmed at _s sid Repair Tight ❑ osid osid R.P sid 'Ihe above is certified to be true. Firm Name�c�`� �1 C'� Certifiad Testa��C�A6� (`(1�C��,�� Firm Address �� C o�c c S�c• Cert. Testa No.`�OO 1y�17 Date �� c�\�.s '�'X "15�.�. 7 �/�d�j� Gauge # _331-1 $ Date last accuracy tested aq White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IItRIGATION DOMESTIC FIRELINE� Y BACI�'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT .;� NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '�J E� PC �400 S• N� ��C ��v17. o�e� �X • The bacl�low preveatioa assembly detailed below has beea tested and maintained as required by TNRCC regularions aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY � Rcduccd Press�ure Principlc e Pressur�Vacuimm Breaktr Double Chcck Valvc � Amnosphere Vacuum Bnaker Manufacnaer �F�C� Size � �l� Model Iv�ber �� Located At �`St� v�lP s«��x�v« �� q 71� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Checic Va1ve Ininal Test DC-Closcd Closed Tight ❑ Opeaed at Opened at _csid \ Tight [7 Lcal:ed �sid _nsid � RP-._psid � Lea};ed Did not Opea o L,eal:ed o �P� aad Mataials Used Test Aftet DC-Closed Closed Tight o Opeae�at Opmed at �sid Repair Tisht o flsid _osid R.P sid The above is certifie�to be tcue. Firm Name�e�•\ �1« Catified Tena��C�°��0 �1�('.�E,��`' Fi:m Address 1��h C o,c c S�c• Cat Tester No.`�401y�1=D� � ��\�s '�'X "15��. 7 � J�/�, Gauge # 33��7 $� � llate Isst accuracy tested ol.� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy CHBCK ONE: IRRIGATION DOMESTIC FIRELINE� v BACI47,OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT � NAN�OF PWS: CITY OF COPPELL Pws i.D. � LOCATION OF SERVICE: '�J � PC �StOO S. N14� ��C �\v17. The bacl�low prevmtion asscmbly detailed below has beea tested aad maiatain�as �required by TNRCC regularions aad is certified to be operating within acceptablc parameters. TYPE OF ASSEMBLY e , Rcduccd Pressurc Principle e Pressure Vacu�Breaker � Double Chxk Valve 0 Atmosphere Vacuum Breaker _ �,� Manufacuaer �E�C� Size � ModelIv�ber �� LocaudAt �*S£� �-.7 Serial N�ber �� 1 '1 �-� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Cbecl: ReIief Valve Air Inlet Check Valve Inival Test DC-Closcd Closcd Tight o Opeaed at Opened at ,__csid Tight o Leal:ed osid _,osid �� RP-_psid �;� Did not Opea o Leal►ed o �P� and Mataials Usod Test Aft,er DC-Closed Closed Tight o Opeaed at Opeaod at __nsid Repair Tight ❑ _nsid _osid RP sid The above is certified w be true. Firm Name�e�•\ �>« Catifiod Testa��c1,A6 V �1�C I�,\�� g�pd� "I q�h C o,t c S�c• Cert. Tester No.`��01 y 417 Date�� A\�.s 'C�X "15�� 7 �/ �� Gauge # 331-I $ llate last accuracy tested ol.� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINB� � BACI�'LOW PREVENTTON ASSEMBLY TES'T AND MAINTENANCE REPORT' � NAN�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: �� ta P•C� �StOO S• M4� ��C ��V17. The bacl�low prevmtion assembly detailcd below has bem testcd aad maiatain�as �required by TNRCC rc_�ulations and is ceitifie�to be operating within acccptablc parameters. TYPE OF ASSEMBLY G / Rcduced Prass�rc Principlc e Pressurc Vacuimm Breaksr �}/ Doublc Chcck Valve o Atmosphere Vacuutm Bnaker Manufactiaer �� Siu 1 '( � Model N�ber � S Locaud At �S£(� �$ ScrialNimmber ��C �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V:�CUUM BREAI�R Double Ch�cic Valve Assembly lst Check �ad Checi: ReIief Valve Air Inlet Check Valve Inival Test DC-Closcd Closed Tight o Opeacd at Opeaed at esid Tight ❑ Lcal:cd Dsid _osid ��\ RP•_psid �;� Did not Opea o Leal:ed o �P� and Mataials Used Test Aft�er DGClosed Closed Ti,,Q.ht o Opeacd at Opeaed at �sid Repair Tight ❑ csid _nsid R.P sid The above is cesdfiod to be true. firm Name�e�ce�� \c'� Ce:tifiod Testa �c1�A6 (Yl�C It,�� Firm Address ��h C o�1'c S�c• Cnt Testa No.�001 l Date ��a5 Tx -�s��. � 3/��:/is Gauge # �3�1 $ llate last accuracy tested d1� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iBCK ONE: IRRIGATION DOMESTIC FIRELINE" � BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT � NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '�� PC �400 S. M4� vC ��. The bacldlow prcvmtion asscmbly detailed bclow has beea tesced and maintain�as �requircd by TNRCC regularions aad is ceti5ed to be operating within acceptablc parameters. TYPE OF ASSEMBLY C � Rcduced Pressurc Principle ❑ Prrssure Vacu«Breaker �}/ Double Chxk VaIve D Amnosphere Vacuum Bnaker Manufactsaer ��c o s� 1'l� Model Ivumber �QS� Located At �SQ� I Scrial Nimmber �� 3 �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2ad Checl: Relief Valve Air Inlet Checic Valve Inidal Test DGClosed Closed Tight ❑ Opened at Opeaed at ,__nsid Tight o Lcal:cd �sid __osid �1 RP-_psid Leal;ed Did not Opea O L,eal:e� o �P� �d �� Sl�� o�- v��-� Materials Used Test Afttr DGClosed Clos�d Tight o Opeaed at Opeaod at __osid Rcpair Tight ❑ flsid osid RP sid The above is certified to be true. Firm Name�e�ra.� �\c'� Cerafied Tut�er��°��I �`�l�C I�\�r� Firm Address �q�h C o,c c S�c• Cert. Testa No.`�OO Iy417 Date � p��bs '('X "15��. 7 3/)� C.� Gauge # �3��l $ � llate ]ast accuracy tested �.� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IBCK ONE: IR.RIGATION DOMESTIC FIAELINE� � � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? ;� NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: '�J E� PC� �StOO S. M4� �� v17. \ The bacl�low prcvmtion asscmbly derailod bclow has beca tested aad ma�n O��as �required by TNRCC regulauons and is certified to be operating within acccptable paramcters. TYPE OF ASSEMBLY C Rcduc,�d Pressurc Principlc � Pressure Vacu�Breaker � Double Check VaIvc o Amzosphere Vacuum Breaker Maaufacz�er �£��C� Siu � ��2 - Modei Number ��7y Locatad At �*SL(� 7 Serial N�ber �K � �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Checic VaIve Initial Test DGCloscd Closed Ti,Pht 0 Opened at Opeaed at _csid Ti�t ❑ Leal:ed _�sid �sid ��1 RP-_psid Leal;ed Did not Opea o L,eal;ed O �P� and Materials Used Test ARer DGClosed Closed Tight o Opeaed at Opeae�at _osid Rcpair Tight ❑ _nsid osid RP sid Tbe above is cetifiod to be we. Firm Name�e�`\ ��c'� Catifiod Tutc��c1�°�� 1�C I�,\��`' g�pd� �q�h C o,t c S�c• Cert. Testc No.`�401 1 Date ��b5 Tx ,s��. � 3/��/�5 Gauge # 331-1 $ llate last accuracy tested a� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IBCK ONE: IRRIGATION DOMESTIC FIRELINB� Y BACKFLOW PREVENTION ASSEMBLY TES'T AND MAINTENANCE REPORT .� N�ME OF Pws: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '�J P PC' �400 S• N� �UC ��v17. o�e� �`� • The bacl�low prevention assembly decailed below has beea tasted aad maintained as required bv TNRCC regulations aad is certified to be operating within acctptablc paramtters. TYPE OF ASSEMBLY G Rcduccd Pressurc Principle e Pressure Vacu�B� � Double Chak Valve o Atmospherc Vacuurm Breaker �/Maaufactiaer �.�C O Siu � �- Model Number ��Y Located At �S�� Serial Nimiber �� q � � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2ad Checl: Relief Valve Air Inlet C7uck Valve Inival Test DGClosed Closed Tight ❑ Opened at Opened at esid Tight ❑ Lcal:cd osid __osid ��\\ RP-_psid Leal;ed Did not Opea o Leai:ed o �P� and Mataials Used Test ARet DGClosed Closod Tight o Opeaed at Opmed at �sid Repair Tight � _nsid __osid RP sid The above is certified to be true. Firm Name�e�� \c'� Certifiod Tester��C A61 (�(1�C IE.�� Firm Address ��h C o,c c S�c-• Cert. Testc No.`�001 l Date ��as T� �s�.� 3/��S Gauge # �3,1 $ llate last accuracy tested a4 White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE� Y BACI4Z.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT � N�OF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: '�J � P•C �400 S• Mi� ��C ��. o.�e� �'Y. • The bacl�low prevmtion asscmbly derailed below has baa tested aad maintaincd as required by TNRCC reuulations and is certified to be operating within acceptablc paramcters. TYPE OF ASSEMBLY C� Reduced Pressurc Principle e Pressure Vacui�Breaker 1 Doublc Chcck VaIve o Amnosphere Vacuum Breaker Maaufacuaer ��C C� Siu � ��a- Modei Number llo��/ Lxated At �St(� q Serial Ni�ber C�� 3q� I REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DC-Closcd Closed Ti;ht ❑ Opeaed at Opened at nsid Tight ❑ Leal:ed nsid _osid �,�,l �---Ps�a � I,eal;ed Dia noc opea o Leal;ed o �P� aad Mataials Used Tcst ARer DC-Closed Closed Tight o Opeaed at Opeaed at __osid Repair Ti,�ht � asid _nsid R.P sid T'he above is catifi�d to be true. �� Firm Name Te�•� �\c'� CertiSod TGster��c1�A6 I �1�C�F,�� Firm Address ��h C o�c'c S�c• Cert. Teste No.��001y�1'7 Date pA\bs 'C�� "?5�. 7 �/ ��/ � cauge � �3\1 $ llate last accuracy tested� a� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE� r BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT � NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��J t� PC �400 S• N14i �C �Ov17. o�e� �`f. • The bacl�low prevmtion ass«nbly derailod below has beea tested and maiatained �s nquired by TNRCC regulations and is cerdfied to be opera�ng within acceptablc parameters. TYPE OF ASSEMBLY c /� Reduced Pressurc Principle e Pressure Vacu�Breaker 4' Doublc Chxk Valvc o Amnosphere Vacuum Bresker Maaufact�cr ��J C C� Siu � ��- Modei N�ber �Q�� Located At �S£(� �Q Scrial Number � � �.o�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAKER Double Check Valve Assembly lst Check 2nd Chec�: Relief Valve Air Inlet Check Valve Ininal Test DGCloscd Closed Tight ❑ Opened at Opened at _nsid Tight ❑ Leal:ed nsid _osid �� R.P-_psid L,eal;ed Did not Opea o Leal:ed � �P� and Mataials Used Test After DGClosed Closed Tight o Opeaed at Opeaod at _�sid �� T1�lI � OSId _��DSld R.P Sld T'he above is cerafied to be true. �� Firm Name�e�•\ ��t'� Ce�tifiod Testa��C1�0.6 I �1�C I�,�� Firm Address ��h C o�c'c S�c• Cert Taster No.`�001 1 D� i 'r Dc�\�.s '�'X "15�.�. 7 �/��/�S Gauge # �311 $ llate last accuracy tested o1� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BAC'I4Z,OW PREVENTION ASSEMBLY TES'T AND MAINTENANCE REPORT � NAN�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '��6 E� F•C �400 S� MA �uC ��. The bacldlow prevmtion assembly detailed bclow has beea tested and maintain�as �requind by TNRCC regulations aad is cerdfied to be operating within ac,ceptable parameters. TYPE OF ASSEMBLY e/ Reduced Pressurc Principle � Pressure Vacuum Breaker � Double Chcck Valve o Atmosphere Vacuutm Breaker Maaufact�er ��'>C�fJ Siu � ��- Model Ivumber �O� Locatod At �SC(� �, � Serial Nimmber ��- ��"�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DGCloscd Closed Ti�t ❑ Opened at Opeaed at nsid Tight � Lcal:cd Dsid _nsid �;� RP-_psid Leal;ed Did not Opea O L,eal:ed O �P� and Materials Used Test ARer DC-Closed Closed Tight o Opened at Opeaed at _osid Repair Tight ❑ �sid __,osid RP sid The above is certified to be tnu. Firm Name Te�r�•� �1 c'� Certifiod Tester��C�o•�I �1�C IE,��`' g�pd� '1 q�h C ar C S�c• Cert. Tester No.`�OO IyQI'7 Date D�\�s �'� �5�. 7 7j��.l�.� Gauge # 331-1 $ Date last accuracy tested a� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE� Y BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? � NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: '�J �a PC' �St00 S• M4� �uC ��. The bacl�low prevca�ion asscmbly detailed below has beea testcd and maintain�as �requind by TNRCC regularions aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reducod Pressvre Priaciple � Pressure Vacui�Breaker � Double Chcck VaIve o Amaosphere Vacuum Breaker � Manufactiaer �F��Cn Siu 1 .Z Model Numbcr �Q� Locatad At �'S�(� �� Serial Nimmba �� "�5 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Double Ch�ck Valve Assembly lst Check 2nd Chec{: Relief Valve Air ldet Check Valve Initial Test DGClosed Closod Tight ❑ Opeaed at Opened at nsid � Tight ❑ Leal:ed �sid _nsid �� RP•_psid Leat;ed Did not Opea O L,eal:e� o �P� and Materials Used Tcst ARer DC-Closed Closed Tight o ppened at Opeaed at __osid Repair Tight o _nsid _osid RP sid The above is ccnified to be true. Firm Name�e�'\ �1« Catifiod Tester��c1'�°•�' �l�C�@�� Firm Address ��h C o�c'c S�c• Cert. Tester No.`�001 1 Date ��b5 T� -,s��. � 3�,a /I� cauge # �311 $ Date last accuracy tested aq White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRItIGATION DOMESTIC FIRELINB" � BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? ;� N�OF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��J � PC �900 S� Mli �uC ��. The bac�low preveation asscmbly detailed below has been tcsted aad maintain�as �requiied by TTtRCC reguladons and is cr�tified to be opera�ng within acceptable paramcters. TYPE OF ASSEMBLY c, Rcducad Pressurc Principle ❑ Pressur�Vacuimm Brealcer � Double Chcck Valve o Amnosphere Vacu�Bnaker Manufactzaer ��C Q Siu � ��3- Modei Number � Locaud At �SE(� �� Serial Nimmba �� 9�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2ad Checi: Relief Valve Air Inlet Check Valve Initial Test DC-Closcd Closed Ti;ht ❑ Opened at Opened at nsid Ti�fit ❑ Lcal:ed �sid _nsid -�� RP-_psid Leal;ed Did not Opea o L,ealced O �� Mataials �P`'�`'�JC�� 1� Q Used Test AR,er DC•Closed Closed Tight o Opeaed at Opme�at __nsid Repair Tight o _�sid __osid RP sid The above is catifiod w be true. Firm Name�e�\ �1�L Cextified Tester�`c1'�A6 �l�C I�,\�1`' Firm Address �� C o�c c S�• Cert. Test�er No.`��O 1y�11 Date DA\�.5 �'X "15�� 7 �j ��./ � Ga e # 3 1 � ug 3, Z llate last accuracy tested oL� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IBCK ONE: IRRIGATION DOMESTIC FIRELINE� v BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? � NaME OF Pws: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE: ��J �a P•C' �t00 S. N� �� Q�v17. � The bacl�low preveation assanbly detailed below has beea tested aad main�ain�as �re xuired by TTVRCC regulations and is certified to be operating within acccptable parameters. TYPE OF ASSEMBLY e Rcduced Pressurc Principlc � Pressurc Vacu�Breaker #� Doublc Chcck VaIve � Atmosphere Vacuum Breaker Manufact�aer �-��Cc� Siu � � �.2 Modei Iv�ber ��11 Located At �S�C� �`i Serial N�ber �� 5� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check Valve Assembly lst Check 2ad Checl: Relief Valve Air Inlet Check Valve Ininal Test DGCloscd Closed Ti;ht ❑ encd at Opeaed at esid Ti�t ❑ Lcal:cd nsid _nsid _�`� RP-_psid Leal;ed Did not Opea o L,ealced o �P� and Matcrials Used Test ARet DC•Closed Closed Tight o Opeaed at Opme�at �sid Repair Tight ❑ _,�sid _osid RP sid The above is cerafied to be true. Fi:m Name�e�\ �\c'� Cectifiod Tena��C�o•6 I �(1�C It,��`' Firm Address ��h C o�t'c S�• Cert. Tester No.`�OO ly�l'7 Date D��.s Tx �s��. � 3/,��S cauge � �3 t 1 $ Date last accuracy tested a� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IR.RIGATION DOMESTIC FIRELINB" Y BAC�'LOW PREVENTIUN ASSEMBLY TEST AND MAINTENANCE REPOR? � NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: '�J P PC �400 S. M4� �� v17. The bacl�low prevention assembly detailod below has baa tosted aad maintain�as �re xuirod by TNRCC regularions and is cerdfied to be operating within acccptable paramtters. TYPE OF ASSEMBLY � Reduced Pressurc Principle ❑ Pressure Vacu�Brealcer Double Check Valve o Amiosphere Vacuum Breaker Maaufact�er �-��G`� Siu I ��- Model Ivumber `�� Located At �`SQ� ,� 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 Ininal Test DGClosed Closod Ti�ht _� Opeaed at Opeaed at _csid � Tight � Lcal:cd nsid _nsid �� R.P-_psid L e a l;e d D i d not O pea o L,e a l:e d o �P� and Mataials Used Test After DGClosed Closed Tight o Opeaed at Opea�at __nsid Repair Tight ❑ _nsid __osid R.P sid The above is c�stified to be true. Firm Name�e�� \c'L�- Cerrified Testa��C1�o.�I f Yl�C I�,\��`' Firm Address 1��h C o�t'c S�c• Cert. Teste No.`�4Q 1 1 Date D��S �'x �S��. 7 ��I.2.�I5 Gauge # _33�-1 $ Date last accuracy tested a� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE� v BACICF'LOW PREVENTION ASSEMBLY TES'T AND MAINTENANCE REPOR? � NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: ��6 � PC �400 S• N� �C ��v�07. o.�e� �y. • The bacl�low prevention asscmbly detailod below has beea tested aad maintained as required by TNRCC regulations aad is certified to be opera�ng within acccptablc parameters. TYPE OF ASSEMBLY e , Rcducad Pressurc Principlc e Pressurc Vacu�mm Breaker �/ Double Check Valve o Atmosphere Vacuum Breaker Manufact�er ��Q Siu � ��— Modei Ni�ber � Located At �St� 1� Serial N�ber P�' �0 7� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUi1M BREAKER Double Check Valve Assembly lst Check 2ad Checl: ��{��ve Air Inlet Check Valve Ininal Test DGCloscd Closed Tight o Opened at Opeaed at nsid Tight o Lcal:cd Dsid _nsid RP•_psid �e''` Leal;od Did not Opea D Leal:e� ❑ �P� aad Materials Used Test Aft,er DC•Closed Closed Tight o Opeaed at Opmed at __nsid Repair Tight o _osid _osid RP sid The above is catified to be tnu. �_ � Firm Name�e�� 1 C'� Cectified Tester��C�°•6 I �1�C It,�� Firm Addeess ��h C o�c'c S�C-• Cert. Tester No.`�001 1 Date D��S Tx ,s��. � 3�,,��,5 cauge # �311 � llate last accuracy tested a�1 White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE� � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT � NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: '�J t� PC �St00 S• N�4i ��C �\v17. The bacl�low preveation asscmbly detaile� below has beea iesied aud ma�n�� n�� bv 'INRCC regulations aad is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY c� Rcduccd Pressurc Principle � Pressur�Vacu�mm Breaker 5�' Double Check Valve o Atmosphere Vacuutm Breakec Manufact�aer `��C� Siu � l�2 Model Ivumber �Qc'� Located At �St(� �� Serial N�ber ��- �.�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembty lst C3eck lnd Checl: Reiief Valve Air Inl�t Check Valve Inival Test DGClosed Closed Tight ❑ Opeaed at Opened at _osid � Tight o Leal:ed �sid _nsid �� R.P-_psid Leal;ed Did aot Opea o Leaked 0 �P� aad Materials Used Test After DGClosed Closed Tight o Opened at Opea�d at �sid Repair Ti,�ht o �sid _nsid RP sid The above is cerafiod to be tiue. Firm Name�e�`\ �\C'� Certified Testa��C�0•6 M�C IE,��`' Firm Address �� C o�c'c S�c• Cert. Teste No.`�0 01 y 417 Date �A\Vas '("X "15�� 7 ��/� Gauge # 33 e-1 $� r � r llate last accuracy tested oLg White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IBCK ONE: IRRIGATION DOMESTIC FIRELINE� � BAC'I�Z.OW PREVENTTON ASSEMBLY TEST AND MAINTENANCE REPORT � NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '��! � PC' �StOO S� MA ��C �\v17. o�E� '�X • The bacl�low przveation asscmbly detailed below has bxa testod aud maintained as rcquired by TNRCC regularions aad is ce:tified to be operating within acceptable paramcters. TYPE OF ASSEMBLY C Rcduccd Pressurc Principlc � Pressurc Vacu�Brcalcer � Double Chxk Valve o Atmosphere Vacuum Breaker Manufacturer ��C� Siu � +/ �- Model N�ber � Locaud At �`Sf C� � q Serial N�ber �� l4 Z2 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check Znd Checl: Relief Valve Air Inlet Checic Vaive Inidal Tcst DGCloscd Closed Tight ❑ Opeaed at Opeaed at osid � Ti�t a Lcal:cd �sid _nsid � RP-_psid / L,eal;ed �I Did not Opea O Lealced O �P� and Mawials Used Test ARer DGClosed Closed Ti,,ght o Opeaed at Opme�at �sid Repair Tight � flsid __osid R.P sid Tbe above is certified to be true. Firm Name Te�•� �\c'� Ce�tifii�d Tena��C�A�� 1�C IE,�� Fiim Addr�s ��4h C o�c'c S�c• Cert. Testes No.`'��OO iy , 17 Date ��s Tx �5�. � 3 �.�. ts Gauge # 33 e-1 $ / / llate last accuracy tested a� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IR.RIGATION DOMESTIC FIRELINS � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT � NAME OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: ��! t� P� �400 S• N� ��C ��v17. o�� '�'`� • The bacl�-tlow preveation asscmbly detailed below has beea tested and maintained as required by TNRCC regulations aad is cerdfied to be operating within acceptable paramtters. TYPE OF ASSEMBLY e/ Raiuced Pressurc Principlc e Pressure Vacu�Break,er ,� Double Chcck VaIvc ❑ Atmosphere Vacuum Breaker Maaufactiaer �C� �7 CC� Siu 1 � �� Modei N�ber � S Locatcd At �*S�(� �� Serial N�ber �� 5 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Valve Initial Test DGCloscd Closod Ti;ht 0 Opeaed at Opeaed at nsid Ti�t o Leal:ed osid __osid �y 1 R.P-_psid Leal;ed Did not Opea o Lea1►e� o �� and Materials Uscd Test A.ft�er DC-Closed Closod Tight o Opeaed at Opmed at �sid Repair Tight 0 flsid �sid RP sid 'Ibe above is cerdfi�d to be tnu. Fi:m Name�e�•� �1 c'� Catified Tester��C�0�•6 0 �1�C It,\��`' Firm Address ��h C at c S�c• Cat Testv No.`�001y�1'] Date De.\�s �'X "15�. 7 �j/)� ( Gauge # 33�-1 �� llate last accuracy tested aq White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIBELINE� � BACI�'LOW PREVENTION ASSEMBLY TES?AND MAII�ITENANCE REPORT � NAN�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '�J c� PC' �400 S� M� �uC ��. o�e� �x . The bacicflow prevention assembly detailod below has beea tested and maintained as required by TNRCC regulations and is curified to be operating within acccptable paramtters. TYPE OF ASSEMBLY C Reduced Press�ure Principlc e Pressvr�Vacu�Bnaker � Double Chcck VaIvc o Atmosphere Vacuum Breaker Maaufactiaer ��Cn Siu � ��\, Modei N�ber QS Located At �`S�� a l Serial N�ber ��"l � 7 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULJM BREAI�R Double Check Valve Assembly lst Cherk 2nd Checl: Reiief Valve Air Inlet Check Valve Inidal Test DC•Closcd Closed Ti�t o Opened at Opened at _csid Tight � Leal:ed nsid _osid c�,1 �-_ps�a L,eal:ed Did not Opea D Leai:ed O �P� and Materials Used Test Aft�er DGClosed Closed Tight o Opeaed at Opeaed at __nsid Repair Tight o _flsid osid R.P sid The above is cerafied to be true. Firm Name�e�'\ ��c'� Cerdfied Tester��c1�A6� (�(1�C IE,\�� Firm Address ��h C at c S�• Cert. Testc No.`'��401y417 Date Dt�\�p,s '('� �5�,.� c�auge # 331-1 $ 3/�a/f5 Date last accuracy tested a� White- Customer's Copy Yellow - City Copy Pink -TesteNs 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: ��J � P� �400 S• MA �vC ��. The bacldlow prevmtion asscmbly detailed below has been tested and maintain�as �required by TNRCC regulations aad is cerd5ed to be operating within acceptablc paramcters. TYPE OF ASSEMBLY � Reduced Pr�essurc Principle ❑ Pressure Vacu�Breaker Doublc Chcck Valve o Aunospherc Vacuum Breaker 1 ►( Maaufacciiarcr � Siu 1 �- Model Number �QS Y Located At �`SQ� �'� Serial Ni�ber �1--�� 7 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Ch�ck Valve Assembly lst Check 2ad Chec�: Relief Valve Air Inlet Check Valve Ininal Test DGCloscd Closed Ti�t ❑ Opeaed at Opened at osid \ Tight ❑ Lcal:cd nsid _nsid �� R.P-_psid Leal;ed Did aot Opea o Leal:ed O �P� and Materials Used Test Aftet DC-Closed Closed Tight o Opeaed at Opmed at _�sid Rcpair Tight ❑ �sid _osid R.P sid The above is certified to be true. Firm Name�e�� C'� CeriiStod Tester��C�o•g� m�C 1�,��+� Firm Address ��h C o�t c S�c-• Cert. Teste No.`��01 l Date Dt�\bs '('y� "l 5��..7 3 �a / f�s cauge # _�311 Z llate last accuracy tested_ a� i� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINS� � BACI�'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT ;� N�oF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:��1e�C,C`(�� PC��cces �400 S. MA ��-��C �\v�7. o�e� �x . The bacl�low prevmtion assembly detailod below has beea tasted aad maintained as required by TNRCC regulations and is certified to be operating within acccptablc parameters. TYPE OF ASSEMBLY C / Rcduccd Pressurc Principlc ❑ Pressurc Vacut�Breakcr :�' Doublc Chxk Valvc o Atmosphere Vacuum Bnaker i Maaufact�er �E Siu � �a-- Model Number O�-�� Located At �`S�(� � Serial Ni�ber C iRC��' �@P1� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUtTM BRF.AKER Double Check Valve Assembly lst Check 2nd Checi: Relief Valve Air Inlet Check Va1ve Ininal Test DGClosed Closed Tight o Opened at Opeaed at osid Tight ❑ Lcal:cd �nsid _,osid Fy�\ RP-_psid Leal;ed Did noc Opea o I,ealced � �P� aad Mataials Used Test After DC-Closed Closed Ti,rht o ppeaed at Opeae�at _�sid Rcpair Tight ❑ _osid __,osid RP sid The above is catifiod w be t:ue. Firm Name�e�`\ �\c'� Ceccified Testa��C��•�� 1�C fF,�� Firm AddeGss ��h C o�1'c S�c• Cert. T�tes No.`'��OO 1y�17 Date ��a5 �x �s��. � 3�1� 15 cauge # �3\1 $ llate last accuracy tested a� (-� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIftELINS� � BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT .� NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��J P PC �400 S. M4� ��C ��v�. a�e� �x . The bacl�low prevmtion assembly detailed below has beea tested aud ma+*+L�ed as required by TNRCC regularions aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C , Reduced Pressure Principle ❑ Pressure Vacui�Breaker 5Y� Doublc Chxk Valvc o Atmosphere Vacuum Breaker �sje�C� s� � �� ► Manufactiaer Model Number ��' Locatod At �S�� L 1 Serial N�ber \�I� �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Check Valve Assembly lst Check 2ad Checl: Relief Valv� Air Inlet Check Valve Initial Test DGClosed Closed Ti,�ht o Opened at Opened at _osid Tight ❑ Lcal:ed �sid _nsid ��`1 RP-_psid Leal;ed Did not Opea O Leal►ed D �P� and Materials Uscd Test ARer DC-Closed Closed Tight o ppeaed at Opeaed at �sid Repair Tight ❑ _nsid _osid RP sid The above is certifiod w be we. Firm Name�e�`� ��c'� c�s�a T��;��A�I m��,�� Fi:m Addrt.ss 1��h C o�t c S�• Cat Testa No.`�Y001 1 Date ��5 �-� -�s��. � 3/��15 Gauge # ��,1 � llate last accuracy tested�dL�_ 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: '�J � PC �400 S• N1t� ��C ��1'7. The bacl�low preveation assembly detaile� below has baa tested aad ma�n�� nq�� bv TNRCC regulations aad is cartified to be operating within acceptable paramtters. TYPE OF ASSEMHLY c Rcduced Pressvrc Principle e Pressure Vacu�Breaker � Doublc Chcck VaIve o Amnosphere Vacuum Breaker Maaufact�er ��°)CC1 Siu � ��-�- - Modei N�ber ��Y Locaud At �S�C� 1 1� Serial Ni�ber �1�� `1 � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd C3ecl: Re(ie{Valve Air Inlet Check Vaive Ininal Test DC-Closcd Closed Ti�t Opeaed at Opeaed at nsid Tight Lcal:cd ❑ Dsid _nsid �E�S �_ '�PSid � � Leal;ed ❑ Did noc Opea o L,eal:ed o �P� and Materials Used Test ARer DC-Closed Closed Tight o Opeaed at Opeaed at __nsid Rcpair Tight ❑ �sid _osid RP sid The above is catified to be true. Firm Name�e�� \c'� Catifiod Testa��C�0�6 I �1�C If,�� Firm Address �� C o�c�c S�• Cat Tater No.`�OO 1y41'7 Date �► D��.S Tx �S�. 7 Gauge # 33�-1 $ �/��.� llate last accuracy tested d1� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIBELINS r BACI�Z.OW PREVENT'ION ASSEMBLY TEST AND MAINTENANCE REPOR? .;� NAN�OF PWS: CITY OF COPPELL PWS I.D.# LOCATION OF SERVICE: '�J t� P•C' �t?OO S. N14� �uC ��. o:�e� �x • The bacl�low pieveation assembly detailed below has beea tested and maintained as required by TNRCC regulauons and is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY e Reduccd Pressurc Principle e Pressur�Vacuimm Breaksr � Double Chcck Valve o Atmosphere Vacuum Bnaker l J �t � Maaufact�cr �E�n Siu I � Modei Ni�ber `1 , Locaud At �*SQ(� �� Serial N�ber � �� +�lU REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiJM BREAI�R Double Check Valve Assembly lst Cherk 2nd Checl: Relief Valve Air Inlet Checic Valve Inidal Test DC-Closed / Closed Ti;ht Opened at Opeaed at _nsid Ti d Lcal:cd ❑ csid __osid �'��7 R.P�.psid � � I.eai;ed o ' Did not Opea o L,ealced � �P� and Mataials Used Test After DGClosed Closed Tisht ❑ Opeaed at Opeaod at __�sid Ftepair Tight � �sid nsid R.P sid The above is certified to be tnu. Firm Name�e�a� �\C'� Certified Testa��C�A6� �1�C IE,��`' Firm Address ��h C o,r c S�c• Cert. Testc No.`�401 1 D� � ��b5 �-,� �s�� 3�� Gauge # 33��7 $ / llate last accuracy tested d1� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINS � BACKFLOW PREVENTION ASSEMBLY TEST AND MAIIVTENANCE REPOR? .� NAN�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��J � P•C �400 S� Mti �uC ��. o�e� �'x . The bacl�low prcveation assembly detailod below has beea testod aad maintaiaed as required by TNRCC regulations and is certified to be operating within acceptable paramcters. TYPE OF ASSEMBLY e/ Reduced Pressurc Principle � Pressurc Vacu�Breaker � Doublc Chcck Valve o Amiosphcrc Vacuum Bresker Maaufact�cr �'�.J C� S iu 1 �� Modei N�ber �� Located At �*S�(� �j Serial Number �0��q �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Va1ve Inidal Test DGClosed Closed Ti;ht Opeaed at Opened at osid Ti� Lcal:cd ❑ �sid _nsid � RP- •n Dsid Z I,eal;ed o �� Did not Opea O L,eal:ed o �P� aad Materials Used Test Aft�et DC-Closed Closod Tight o ppeaed at ppeaed at __nsid Repair Tight � �sid _osid RP sid The above is catified to be we. Firm Name�e�� \c'L Certified Tester��C�0`6 �1�C I@�� Fiim Address �qah C o�t c Stic• Cert. Testc No.`�401y417 Date �� ' D��.S T� -,s��. � 3 � S Gauge # 33,�1 $ �� /� llate last accuracy tested a� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy