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2015_0603 C�IECK ONE: IRAIGATION DOMESTIC /` FIRELINE BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT' NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE: �� `� JC� .a %/ The back�flow preveation asscmbly detailod below has baa testod aad maintained aS required by TNRCC reguladons aad is certifiod w be operating withia acceptable paramtters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Pressure Vacu�Breakes ;Q Double Chak Valve c Atmosphere Vacuum Brealxr M3II11faCi13tCf ��"t'7�� $iu �i` tv�oa��N,rmber DD`�/�''tl I,ocacea AL � nr� I-�v� s«;�N� �� REDU(�D PRESSURE PRLNCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubi�Chedc VsMe A�T lst Check Znd C� Rdief valve �1ir Inlet Ch�ck Valve Initial Test DC-Closed '�'L .Z Ciosed Tight �f Ojxacd at Opexd at _�flsid Tight � Lesked Z.C1 0 _�d osid RP-_psid �� ❑ Did aot Opea � Leaiked � �P� and Mataials Used Test Aftet DC-Closed Closed Tight o Opeaod at Opeaod at __flsid Repair Tight ❑ esid �sid Rp 'd The above is catified to be true. Ficm Name�I(��ti� ��- I'�:'�'-,� — Catified Te.strr �� ;r't��t: '-`��Y� Firm Address � � < '�'' Cert. Tastc Na � �'� Date��' C IK(N��t�r-,�,. �; ��`� �8� � ��r��-x.� �� Date last accuracy tested� � ''- C�IECK ONE: IRRIGATION DOMESTIC � FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # � • .� ,/� LOCATION OF SERVICE: �a�"lt> u � /�.1��" The bacl�low preveation assembly detailed below has baa testod aad maintained as required by INRCC reguladons and is cctified W be operatiag within acceptable paramtters. TYPE OF ASSEMBLY e Reduced Pmsurc Principle e Pressiue Vacu�Breaker � Double Chcck Valve o Atmosphere Vacuum Breaket Maaufactvrer �{.lil'�S' Siu 2 �� Model Number �%C.�`��'"l� -- Located At �� ` Serial N�ba -��'Z�.-.� REDUtED P'RE.SSL'RE PRINCIPLE ASSEMBLY PRESSURE VACU[JM BREAI�R Double Chedc V�iv�e Assmbi? lst Check 2nd C�edc Re�ief�alve Air Inlet Check Valve Iainal Test DGClosed Z�O Closed Tight R� Opened at Op�d at __osid Ti�t ❑ Leal:ed %� (� o osid _ns�d RP-__,psid �;� ❑ Did not Opea O L,ealxd � �P�;,t and Materials Used Test After DC-Closed Closed Tight o Opeae�at Opeaed at �sid Repair Tight ❑ �sid _osid Rp 'd 'I'he above is catified to be trne. ,�", ; Firm Name �1��in - �';E% ��:c; � CectiSed Teste \. . G�V� ��.�:�T��` Firm Address�C �jX ��/i' Cat Te.stc No. ��';r�� ` Dace � � f� l�,��.�k�l�� c.�� - -�- Gauge # ��l n�1�� llate last accuracy tested � � C�IECK ONE: IRRIGATION DOMESTIC FIRELINB � BACT�LOW PREVENTION ASSEMBLY TEST AND MAIIVT'ENANCE REPOR? NAN�OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE: �� /�c 't,�� The bacictlow preveation asscmbly detaile� below has ban tested and maintained as raquired by TNRCC re�ulazions and is certified to be opera�ng within acceptable parametreers. TYPE OF ASSEMBLY e Reduced Pressure Priaciple e Pressure Vacu�Break,er �� Double Checic Valve o Atmosphere Vacuum Breaker �� e Maaufact�er � 1CG�f� Siu � Modet Iv umber C��M/ Locaced At /�`� �r--� %�4c�i-�- Strial Iv�ba �� REDtJ(�D PRESSURE PRLNCIPLE ASSEMBLY PRESSURE VACULTM BREAI�R Double Checic V:fvoe AsumbiT lst Check Znd C�ed: ReGef�atve :a1ir Inlet Check Va1ve Iaival Test DGClosed 2�� , Closed Ti,�ht � Opeaod at Opcaed at osid Tight 1� I.eal:ed '��G3 p _�d �id Rp- �sid �;� o Did not Opea o L.ea1,-ed ❑ �P� aad Materials Used Test After DC-Clos�d Closed Tight o Opeaed at Opeaed at _flsid Repair Tight D esid �osid R.P The above is certifiod to be tcue. , + FirmName � �c�`�..-_ CatiSedTesta G�f�'►� r�L�`-=�1�f'; Firm Address � ��>'�� l`�`� Cert. Tester No.�� f�;�i C�r�� Date � �� i,�i.�'��!� i ;r:�r.►-9 �_� 0 � Gauge # C�l> //�'7t}�7�� llate last accuracy tested '� ' !� . , C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATIOIv'OF SERVICE: l�On �� /<r.>�c;'% The bacl�low preveation assc.mbly detailod beloa has been testod aad maiatainod as requu+od by TNRCC re_guladons and is catified to be operaung within acceptable paramcters. TYPE OF A.4SEMBLY c Reduad Pressure Priaciple e Pressure Vacu�Breaker ;� Double Check Valve ❑ Atmosphae Vacuum Breaker Maaufacuaer L��.�'i��5� Siu �� Model Iv�mmba �70�1 Located At /U� �1�.� �'�r w % �� Serial lvimmba %�S<:��7 REDUCED PRESSiJRE PRINCIPLE ASSEMBLY PRESSURE V:�CUUM BREAI�R Double Cbedc V sh►e A�IT lst Check 2nd C�edc R�id�atve Air Inlet C6eck Valve Ininal Tesi DC-Closed Z,� Closed Ti,ht � Opeaed at Opeaed at __nsid Tight �f Leal:ed �e� � _�sid _nsid RP-__psid I,eal;ed o Did not Opea � Leal.rod � �P� aad Materials Usod Test After DC-Closed Closed Tight o Opeaed at Opeaed at _._Qsid Repair Tight a flsid _,osid RP 'd The above is ccti5ed to be tinse. Firm Na�e �G�-r�r`� �i�'-�_ �/�s Cctifiod Tester f.�l,�Sl)vr �z.�"7��'! Firm Addc�ess �� 0� 7l�� C�.��ur,rGr�c:t�i,� Cert Testc Na ��1i�6.�� Dace--�'T=�� Gauge # �� Date last accuracy tested �y ��' / C�IECK ONE: IRRIGATION DOMESTIC FIRELINE x BACI�LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAI�OF PWS: CITY OF COPPELL PWS I.D.# LOCATIOIv'OF SERVICE: ��7L7 �-� ✓�oy�� The bacl�low prevention assembly detailod below has beea ttsted aad maintained as req�ured by INRCC re_Quladons and is certified to be operating arithia acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressurc Principle e Pressure Vaeu�Breaksr � Double Check VaIve G Auaosphere Vacuum Breaker Manufacturer /A�u��.5� Siu �� ` Model N�ber GC7 7/'�! Locate�At �S'/✓ �iv-e' il�u/�- Serial N�ba ��/Z � REDUC'ED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUiJM BREAI�R Double Chtcic V alve l�b� lst C3eck 2.nd Cbec1: Re�ef Yatve :�ir Inlet Check Vah►e Iaitial Test DC-Closed Closed Tight �8' Opeaod at C)pwed az .�d Ti�t �� ,�# I,eal;ed f�Pj o _��sid lpsid RP- �sid u� ❑ Did not Opea o Lea�xd � �P� aad Mataials Used Test ARer DC-Closed Closed Tight o Opened at Opmod at _�sid Rcpair Tight o _nsid __,osid RP 'd The above is certifiod to be orue. Firm Name ' ��r� ��y �'�� Certified Testc ��.S��t l�ti'S�'r7zn _ - � FirmAddress��:'x�-�;'�'.7L�C�K��I<,C�r� Cert. Testallo. �I�C��'._��•5'% Date � � -�� t�" Gauge � C�'�i�l/l��)��'� Date last accuracy tested � ' C�IECK ONE: IRItIGATION DOMESTIC FIRELINE � BAC'KF'LOW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT' xaME oF Pws: CITY OF COPPELL PWS I.D.# LOCATIOIv'OF SERVICE: ��'� :.S �'[�c.�G I� The bacl�low prevmtion assembly detailed below has bera testod aad maintaiaed aS required by TNRCC re_atilarions and is certified to be operadng within accrptablc pararmcters. TYPE OF ASSEMBLY e Reduc,ed Pressure Principle e Pressure Vacu�Breatcer ,� Double Check Valve ❑ Atmosphere Vacuum Braaker Maaufactsaer <<l 1�,��:5� Siu �� i N�� 7a 9 r.�a At _ G� {�r�-� �� - s«�N� Ci y3�� RFDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACULJM BREAKER Double Check V alvoe Asa�bly lst Check 2ad� Re�ief�alve :�ir Inlet Check Va1ve Initial Test DC•Closed, ; Closed Tight D` dpe�cd at Opeaed at _nsid Tight 2��',� Leal:ed Z-� � __�d nsid RP-__psid I,�;� ❑ Did not Opea o Leaixd o �� and Mataials Usod Test A.fter DC-Closed Closed Tight o Openod at Opmod at �sid Repair Tight ❑ _�sid _�osid RP 'd T!u above is ce�ti6ed to be Cnu. Firm Na�e �C`�/'U'v;�i V� +l'�t S _ Certifiod Testa i;�C%'r �,��iZ,�1 Fitm Add�+ess/`�D ��X /i � Cert. Tester No. ��Cx.�i L�C�:;f Date -�'/.� C�cL�k�G�r�'�.'�� . Gauge � ' � � `"` Date last accuracy tested l ,.� L