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2014_1008 C�IBCK ONE: IRRIGATION V DOMESTIC FIRELINE BACI�'LOW PREVENTION ASSEIV�LY TEST AND MAINTENANCE REppRT NAIv�OF PWS: ,��e l� � � 1 i�� It� �[^Xl�� c.`�'--i-� PWS I.D. # LOCATION OF SERVICE: � �� tCh� 1 fOiCe- The bacl�7ow prevartion asscmbly decailod below has beea tested aad maintaiaed as required b�, 'I'NRCC reguladons aad is certified to be operating withia acceptable paramcters. TYPE OF ASSEMBLY ❑ Reduced Pressure Principle ❑ Pressure Vacu�Breaktr ;� Double Check Valve o Atimosphere Vacuum BreaLer Manufaccurcr ��S Siu Z�� Model Number C�""'C l�Yl � ��T Located At �, �as�` a � I ro�c(c �A�'r G�{ Serial N�ber �`I'� � 5 2 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Doubie Check Valve Assembly lst Check �, '7 2od Checl: � �5 Reiief Valve Air Inlet Check Valve Initial Test DC•Closed Closed Tisht I� Opened at Opened at esid Ti�i �t Leal:ed O nsid __nsid QaG�� RP-_psid v L,eal:od ❑ Did not Opea ❑ L,e�alced o �P� aad Materials Used Test After DC-Closed Closcd Tight o Opeaed at Opeaed at _nsid Repair Tisht ❑ _��sid nsid RP sid The above is catified to be tnu. Finm N _ � I��5� Catified Testa ► , Firm Address,�O � �� Cert Tester No. � Date ��/� 1��` Gauge # �'�('�(�')d llate last accuracy tested White-Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION �` DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEN�LY TEST AND MAINTENANCE REppR? NAIv�OF PWS: l�pPel� 1 � 1�C��e JC�p 0� �CX'� PWS I.D. # � Z.0 I�C��- � e I' LOCATION OF SERVICE: s � ��' The baci�low prevmtioa assembly decailod �low has bem tested and maintaiaed as required by TNRCC regulauons aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑ Reduced Pressure Principle o Pressure Vacuum Breaker � Double Check Valve o Atmosphere Vacuum Breal:et !- I � Manufactzaer ��T � Size � Modei Numbcr QQ7 � � � Located At � ��'��O.C-� �eSt�. �,�� E RS Serial Numnber REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check Valve Asaembly lst Check 2nd Checl: Relief Valv� :�ir Inlet Checic Valve Initial Test DGClosed Closed Ti�ht o Opeaed at Opened at esi_d Ti�t ❑ Leal:cd o �sid __�osid RP-_psid Leal:od ❑ Did not Opca ❑ Lealced ❑ RePairs and Matrrials Used Test AR,er DC-Closed Closed Tight o Opeaed at Opcaod at �sid Rapair Tight D _osid nsid RP sid The above is certified to be true. Firm Name�Q p�I ` �.�� Certified Testc �C�.v�� I.X� 1 I 1��SV�a � � Fi:m Address �� Cert Testc No.��ate �C� I Gauge # 2�� 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 MAINZ'ENq1V +REppR'T NAME OF PWS: �j(��`P_ �[��n I I� x�V� PWS I.D.# LOCATION OF SERVICE: I � IV Q-t(�� TGtC� T'he bacl�low preveadon asscmbly decailed below has beea tested aad maintained as required by TNRCC reguladons aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑ Reduced Pressure Principle o Pressure Vacuuai Breaker � Double Check Valve o Amzosphere Vacuum Brealer Manufacturer (.e�a'�t5 Size �'�� Model Number .�/"Y1 '� Located At �. o� g cY�o� Ect y{-. Serial Nimmber �� REDUCED PRESSURE PRINCTPLE ASSEMBLY PRESSURE VACiJUM BREAKER Doubie Check v alve Assembly lst Check ( , 2nd Checl: Z. Relief Valve Air Inlet Check Va1ve Inival Test DC-Closed Closed Ti�ht Openai at Opeaed at esid Ti�i �CC Leal:ed � �sid _�nsid R.P-_psid Lealxd o Did not Open o L,ealced o �P� aad Materials Used Test ARrs DC-Closed Closed Tight O Opeaed at Opca�d at _nsid Repair Tighc a _�sid __nsid RP sid The above is certified to be true. Firm Name �D�P�I .L � ` �. _ Certified Testa Fi:m Address � � r' �►�Cat Testa Na ate��T Gauge � Z�")�� llate last accuracy tested White-Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IBCK ONE: IRR.IGATION_� DOMESTIC FIftELINE BAC'I�LOW PREVENTION ASS LY TEST AND MAINI'ENANCE REppRT NAME OF PWS: �pjP�II �� -- SC�Q^j' N 0►r'-}h PWS I.D.# LOCATION OF SERVICE: ( Z`� NG��S rr.Lc:;� The bac�-tlow preveation assembly detailed below has beca tested aad maintaiaed as required by TNRCC reguladons aad is cerdfied to be operating within acceptable paramcters. TYPE OF ASSEEMBLY o Reduced Press�e Principle � Pressure Vacu�mm Breaktr �` Double Check Valvo o Atmosphere Vacuum Breal:er Manufact�u�ez �T S Size z�� Modei Number W� I ' 1 � �� Located At 5 0� S� h op� W e�-} c�. Serial Nimnber �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLT[JM BREAKER Double Check Valve Asaem6ly lst Check Z•z- ?nd Checl: Z-� �ef Va1ve tir Inlet Check Valve Inidal Test DC-Closed Closed Ti;ht � Opeae�at Opeaed at _esid Ti�t � Leal:ed o �sid __�osid GS� �-��S�a Leal:ed • o Did noc Opar o I,eake� ❑ RePairs aad Materials Used Test ARer DC-Closed Closai Tight ❑ Opened at Opcaai at _flsid Repair TighL � _nsid osid RP sid 'Ibe above is certifiod to be true. Firm Name � i� �Sl.� c��a r«� au i d � l , F�a� 13D?� r c� r�No. ��n� �� I Gauge # Z�(�� llate last accuracy tested +1 � '� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: �. P Z IRRIGATION DOMESTIC FIRELINE BACKF'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: f�C� I VC��,�� ! ►�(�1 �D The bacl�low prevmtion asscmbly detailed below has beea tested aad maintain� � nq� bv TNRCC regulations aad is cardfied to be operating withia acceptable parameters. � TYPE OF ASSEMBLY Rcduced Pressure Principle C Pressure Vacu�Breaker � Double Chxk Valve o Atmospherc Vacuum Brea�er Maaufactsaer �`��-��-� Siu '3 . Model Ivt�ber �— � �'� ��"� Located Ai � i%i'��-¢`�;��i;�t"1 �� C��1 C�n��C (:n� (��`�� . Serial N�b��3 � 3 I � t REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doubie Check v alve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Inidal Test DC•Closed Closed Ti;ht Opened at Opened at csid Tight � Leal:ed o ��osid osid R.P- �'-?' � Dsid _ I,�;� o Did not Opea o Leal►ed � �P� aad Mataials Used Test Aft�er DC-Closed Closed Tight o ppened at Opeaed at �sid Repair Tight ❑ �sid �osid RP sid The above is catified to be true. � _ Firm Name �1 K,1�(�t�"1 Certifiod Teste � �� -�r � ��r-r� �� i��'�� I �� c.. ___ _-� . r � " � ��r� ��, �� .� c«t. r�xo. ��z`�� n� � ��- �� Firm Address � ��i��i�.�� .�'1 � ��i:�� . , ,, , ,. . - -- Gauge # C�;� �z..�� 1�,- 1�:� llate last accuracy tested `�l� � � = f�� White- Customer's Copy Yellow - City Copy Pink -Tester's Copy C�IBCK ONE: � r Z IRRIGATION DOMESTIC FIRELINB BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAN�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: 1 �-'C� � �{f -��.��-..�?�� YC,�c,�. The bacl�low przvmtion assembly detailed below has beea tested aad maintain� � nq� bv TNRCC reguladons aad is certified to be operadng within acceptable paramcters. � TYPE OF ASSEMBLY Reduced Pressure Principle ❑ Prtssure Vacuimm Breaker ❑ Double Chxk Valve � Atmo ere Vacuum Breaker j � � t° Maaufact�er �;�� Siu � � Model Iv umber �--'� �� i�'�.� Located At ��C'i'��'S`>�� w1+�`�� f£_� r�C�,�..�,:r�e Serial Nimmber �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst Check 2ad Checl: Relief Valve Air Inlet Check Va1ve Initial Test DGClosed Closed Ti,Qht �ed at Opeaed at osid Tight�:� � o Leal:ed o �psid _osid RP-__psid �;� o I}id not Opea O L,eal:ed o RePairs and Mataials Usod : Test ARet DGClosed Closed Tight o ppened at Opme�at �sid ' Repair Tight � �sid __..,osid RP sid The above is cvdfiod to be tive. � �, � �r, � Firm Name � �t - c�r«� T�� r�� .��-�� n Firm Address ��U f``� �L?(�L i t-�°�� (C�� Cat Testc No._�,� �2 '��1� Date � "" Z I - �`' : �'.r (-� � `' ~`�` ��i'� f Cs`! Gauge # ��-�� }<<% j'>�'� � llate last accuracy tested C��- 17- �L� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy