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2015_1016 IRRIGATtO1V DOMESTK FIRELINE �� The following form must be cornpleted fvr each assembly tested. A signed and dated original must be submitced to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION�SSEMBLY TEST AND MAI�iTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570Q4Q (Customer) ,� MAILING ADDRESS: f/liyu�,�� US��/R,�s�,Q � /�� ,,. � 760// CONTACT PER30N/PHONE: �N � �dC �'i�- '�?/— 8��9 LOCATION OF SERVICE: //�v o� �,p��,�� The backflow preventian 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 :�'Reduced Pressure Principle-Detector � ;Doubte Check Valve �uble Checic-Detector -!Pressure Vacuum Breaker :�Spitt-Resistant Pressure`lacuum Breaker Manufacturer_�tRS£`� Madel Number dO�G 1I Size �� Located At �_��_„� �� Serial Number /�0�-S3 v Is the assembly installed in aecordance with manufacturer recommendations and/or local codes? •Pr Reduced Pressure Princi le Assembl Pressure Vacuum Brealcer Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at � �_` sid Held at 2�� p psi_ Clpened at__ Qpened at_ Held at Tnitial Test Cfosed Tight� Closed Tight psid psid ps�d Leakedi ; Leaked ' Did not open I Did not open _' Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened ai Opened at Neld at Repair ClosedTight i ClosedTight ' psid sid P psid Test gauge used: Make/Model %rJ,.e.r2.c.,.. T'�S �N: �J 7 o�v�� Date Tested far Accuracy: 6'/v - >,S" Remarks: The above is certified to be true at the time of testing. Firm Name �� i'ti S Firm Address �� 7y`� C.c%, �%!� 7S/�� Certified Tester(print)�,� � ��_�ertified Tester(signature)=/�� Firm Phc�ne#C/�`�S D 'Z'��1 Cert.T'ester No.g f'�i�. 6 /S� Date ��I��r,.� * 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 IRRIGATION DOMESTIC FIRELlNE �/ The following form must be completed ft�r each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes; BACKFLOW PREVENTION ASSEi�1BLY TEST AND MAINfTENANCE REPORT NAME O�PWS: CIT�OF COPPELL PWS LD. #057�D040 (Cust�mer) MAtLING ADDRESS: ��iL`�'4".�' �a�'S�X��.�L�� ,�iL�, 7 ��/l CONTACT PERSONJPHONE:_�., ad��p,��✓� 8/7�3'7/- �`I'S�9 LOCATION OF SERVICE: /�'/a ��/n,�,,o4,,,.,,t The backflow prevention assembly detailed below has been tested and maintained as,required by commission regutations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY "�Reduced Pressure Principle 1 Reduced Pressure Principle-Detector � �ouble Gheck Valve :!Double Chec;k-Detector -;PressureVacuumBreaker �,Spilt-Resistant Pressure Vacuum Breaker Manufacturer H ��5��/ Model Number ��G Size 3/� Located At _ /(f•� : c�,,,-.� V w„� Serial Number ��Z3 3 Is the assembly instailed in accardance with manufacturer recommendatians and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Sreaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held aV/' �psid Held at �� psid Opened at (3pened at Held at Initial Test Closed Tight� Closed Tight✓� psid psid psid Leaked' ' Leaked ' id not opea ' Qid not open ' Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight' ! Closed Tight ; psid psid psid Test gauge used: MakelModel L✓�'^^ T� � �N: d7o qv��d� Date Tested for Accuracy: �i-/a -l-s� Remarks: The above is certified to be true at the time of testing. FirmName�l��,,L,� � ]�y�S Firm Address ,�9 7�j7 /�cJi�jt,. T!�- �$1�' Certified Tester(print) �a._��ertified Tester(signature) �� Firm Phone#�� .�',3'd -7�z..�7 Cert.Tester No.��'�°� ��3� Date�- �C-/j _ *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 fRRIGATION DOMESTIC FIRELINE V The following form must be completed fvr each assembly tested. A signed and dated original must be submitted to the public water sugplier for recordkeeping purposes; BACKFLOW PREVENTION ASSEMBLY TEST AND MAI�iTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. #Q57004Q (Customer) �wArLrNG ADn�ss: ��►�,, 6aaS,x�i�gs ��. S�� /o� �Rc. Tv 76�i► CONTACT PERSONiPHONE: /Z�0(n►� ��A H iq�•,N 4 �r'?- 37/� �9�`� LOCATION OF SERVICE: �/�0 1�I�fl�,��,.�.� The backflow prevention assembly detailed below has been testecf and maintained as required by commission regulations and is certified to be operating wichin acceptable parameters. TYPE QF ASSEMBLY :!Reduced Fressure Frincip}e -�Rectuced Pressure Principle-Detector � .DoubleCheck Valve �ouble Check-Detector ��PressureVacuamBreaker "-;Spilt-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number 7`�9 ��`ti' Size a � Located At S� �� Serial Number �/ZS^�� Is the assembly installed in accordance with manufacturer recommendations an�d0or(ocal codes? -�2..� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Ualve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at 3'�ps' Heid at L��p� Opened at____ Opened at_ Held at Initial Test Closed Tight _ Closed Tight psid psid psid Leaked': i Leaked id not open ,' Did not open ' Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at ,_ Opened at Held at Repair Closed Tight Closed Tight' ': psid psid psid Test gauge used: Make/Model l��--- T�j e SN: D ��jv C�-�� Date Tested for Accuracy: lo'l D -I..S' Remarks: The above is certified to be true at the time of testing. FirmName�� n� �ydS Fi:rmAddress �v�,� 7�7 (�l��. � ?S�� Certified Tester(print)��C�nO�" Cerkified Tester(signature) �� Firm Phone#_��-S�v— 7�--�� Cert.Tester No.�3 Y�� (/�' -7 Date /�/6�/S * 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 IRRIGATIOf� DOMESTIC FlRELINE i1 The following form must be completed fvr each assembly tested. A signed and dated original must be submitted to the public water sugplier for recordkeeping purposes, BACKFLOW PRE VENT[ON ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL �WS I.D. #0570040 (Customer) �7 MAILING ADDRESS: t�1t��. �UrI S itc-F/R¢s�,� �Q /o� ��,, � 7(oa/( CONTACT PERSON/PHONE: �p N�' - 3�-� _. LOCATION OF SERVICE: />/U /�,�„�nf The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be aperating within accep#able parameters. TYPE OF ASSEMBLY - Reduced Pressure Principle '_ Reduced Pressure Principle-Detector � 1�'15ouble Check Valve _;Double Checic-Detector �-'PressureVacuumBreaker -lSpi11-Resistant Pressure Vacuum Breaker Manufacturer fit/� Model Number OU "7 N�-) Size 3/� Located At S.� . (�n,�,,._.,� �it,�,.�Q� Serial Number S��l3 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 I st Check 2nd Check Held at `•�psid Held at /.� psid �pened at _ (}pened at Held at Initial Test Closed Tight� Ctosed Ti�ht � psid psid psid Leakedi . Leaked ! Did not open Did not open Leaked: Repairs/ Materials Used Held at i psid Held at psid Test After — Openecf at Openui at Held at Repair Closed Tight ' ClosedTight: ' ps�d psid psid Test gauge used: Make/Model ��'�2r�� T�� SN: O'7�q'o'�� Date Tested for Accuracy: t� -/D-/� Remarks: The above is certified to be irue at the time of testin�. FirmName �C� � �,!t/�Firm Address 1P9 � 7�'7 !�✓�.• �, 7,��(.�8 Certified Tester(pr;nt) e r,�,�„� Certified Tester(signature) i�:�.--.�-, � .�� Firm Phone#d�oa� SSO - 2z-8� Cert.Tester No.��ao*� 6/S�7 Uate_�Oj 6-/ _ *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Gop�+ Pink-Tester's Copy IRRIGATION v DOMESTIC FIRELINE The following form must be completed far each assembly tested. A signad and dated original must be submitted to the public water supplier for recordkeeping purpases: BACKFLOW PRE VENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � MAILING ADDRESS: I�IL��e.re� �jOv�Xf/�q�5- /�, fl Iv+� ��1. �i 'v� '� b/l' CONTACT PERSON/PHONE:_/?-.00(,,�e,� PFq/-�,a�� Si 7-��r - 8yN 9 LOCATIOIV OF SERVICE: ///O ��►��,-1' The backflaw prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE O�ASSEMBI�Y uced Pressure Principle 'Reduced Pressure Princigle-Detector : oubleCheckValve _'Double Check-Detector �'PressureVacuumBreaker ^ Spitl-Resistant Pressure Vacuum Breaker Manufacturer �m-e✓ Model Number �tia=' � Size �� Located At �Rs�5-��-��-� Serial Number �ih.uz k-��o�. Is the assembly instalied in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembiy Relief Valve Air lnlet Check Valve i st Check 2nd Check Held at /�,� psid Held at z�psi Qpened at___ 4�pened at Held at Initial Test Closed Tighl� Closed Tight psid psid psid Leaked' 1 Leaked i Did not open Did not open '. Leaked ' Repairs/ Materials Used Held at psid Held at psid Test After - Opened at Opent:d at Held at Repair Closed Tight'. i Closed Tight ' psid sid p psid Testgaugeused:Make/Model G��- �� S SN: O ��gn��'� Date Tested forAceuracy: 6-�a'/f Remarks: The above is certified to be true at the tame af testing. Firm Name �C.�.�„ ��, ��,ro� Firm Address_��$�- '7�j bcley[, �a '7 r�� Certified Tester(print) ,�e.e,,�„.,.p?'�. �i�,��aQti�ertified Tester(signature) __��_� Firm Phane#��'- SS'v �-�'`� Cert.Tester No. 1�P�+� 6/,S 7 Date�-/�-/.S� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Capy Yellow-Customer Copy Pink-Tester's Cogy a IRRIGATION DOMESTIC "� FIRELINE The following form must be completed fvr each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping puzposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAIPYTENANGE REPORT NAME OF PWS: GITY OF COPPELL PWS i.D. #U570040 (Customer) MAILING ADIIRESS: �2�. �o�o .�i3z�=/,o.�s �,�c o /o� f��—�c 7(ob�1 CONTACT PERSON/PHONE: 20 � P�p �/��jy� �i 7.. ?��(� �g c f� LOCATION OFSERVICE: /I/[7 /�f b2-Nk Paou �' The backflow prevention assembly detailed below has been tested and maintained as required by commission regularions and is certified to be operatiug wiihin accepiable parameters. TYPE OF ASSE.ENBI.Y -'Reduced Pressure Principle -",Reduced Pressure Principle-Detector � ✓'IJ`ouble Check Vaive i Double Check-Detector !-:PressureVacuumBreaker ISpili-Resistant Pressure Vacuum Breaker Manufacturer 1�✓��i Model Number d a �r�� Size 2" Located At �E . �-s�,�.o� �/� Serial Number �'�d�8 Is the assembty installed in accordance with manufacturer recommendations and/or lacal codes? -Q�� Reduced Pressure Princi le Assembl Pressuce Vacuum Breaicer Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Heid at�.G psid Held at�� psid Opened at_ __ Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid Leaked'. ; Leaked[1 Did not open 1 Did not open ' Leaked: ! Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair C(osedTight_'. ClosedTight ' psid �id p' psid Test gauge used: Make/Model G��u- � � �N; p 7a qo y�� Date Tested for Accuracy: 6'/��/� Remarks: The above is certified to be true at the time of testing. Firm Name �� y� `��25 Firm Address ,Clc�� 7�l� Gc�st,�C (�t. 7S/lo� Certified Tester(print)7�« � ��_Certified Tester(signature)_/�� Firm Phone# ��"�sb - Z�—�-7 Cert.TesterNo. $j�� o1S�-7 Date /��/G�/{' * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Capy Pink-Tester's Copy