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2015_0610 CIIECK ONE: IRRIGATION DOMESTIC � FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: �-��?`/ G� (-' r�(�� _ % PWS I.D. � LOCATION OF SERVICE: �.�/I cS. K�u 4 I Thc backilo�v prevention assembly detailed belo��� has been tcstcd and maintained as required k�y"I'C�Q regulations and is c�rtitied t� be operatin�ti��ithin aeceptable para���eters. TYPE OF ASSEMBLY ❑ Rcducrd Press�e Principle ❑ Pressure Vacutmm Breaker y�C Double Check Valve ❑ Atmosphere Vacuum Breaker Manufacturer �.�2 hCl> Size ��� Model Ntmiber ��JO Locatcd At t,e�s�- �a�d ho)C sm�r�,�ba 1 I o )� I 9 REDiJCED PRESSURE PRINCIPLE ASSE:�LBLY I PRESSURE VACULJM BREAKER Double Check v a]ve Assemblv lst Cher1: 2ad ChecR Relief VaIve :�ir Inlet Check Va1ve Iaival Tcst DGClosed 2•� Closed Ti;ht � Opcaed at Opened at osid Ti�iit ,� Leal:cd ❑ psid osid RP-_psid 2• � Leai:ai ❑ Did not Open O L,eai;ed o �P� and Materials Used Test ARer DGClosed Clesed Tight o ppened at Opcaed at nsid Repair Tight o nsid osid RP sid The above is cemfied to be a�ue. Firm Name �C04I�v'.e fllDS' Ccrtified Tcsta �S F+r�c7on Firm Address J�O sQ�1X 7�7 /�Q,��/'j1�Cert.Tester Na �D�1')l(�l Date �� Gauge # Q����7�_ llate last accuracy tested � White- Customer's Copy Yellow - City Copy Pink-Tester's Copy CIiECK ONE; IftRIGATION DOMESTIC FIAELINE x BACKFLOW PREVENT'ION ASSEMBLY TEST AND MAINTENANCE REP4RT N.4ME OF PWS: CITY Of' COf'PF_�LI. Pw'S I.D. # LOCATION OF SERVICE: Co// S'. �c¢4.,� Ibc baci�low prcvcntion asscmbly detailad beio� '.�s be� testcd and maintainc� as required by T*+R�C reeulanons and is ccrtificd to be operanng w-ithin a:.�sabic paramctcrs. �,-a= �: .'��.5�'�iBLY C Rcduc;u Pressur ?--,�c:-:i.- = Pressurc Vacuimm Breaker ;� Deuoi�Cacr�:�'a:z�. = Amnosphere Vacuum Brealcr �ia:ac�zac^.zr`: GUu'�S s:,_. 3/�`r 4ioc�ev'ti�m`t� �7�� ��.�: UC�u1� c5'Gv Cdrnpr� S� ��� 4�88��/ � REDUCED PRESSL'RE PRT�CIPi.E AS.SE.'t�L�' � P�L�tE �'ACLZiM BRFAKER � � Double C3eck Vatve Assembiy lst Check 2nd Checl: Reliet'Valve 4ir Inlet � Check�'a1v,e , � Ininal Test DC-Closcd 2' T Closod Tight �' Opcnod at Opeaed at Qsi; ;� k; Ti�ht � I,ca�,:cd� � ❑ �sid osid � `+ � 't2.'- ^sid , ; �� t ;�;�;;� = ! Did not Open ❑ L.ealccd � �� f i � � � ? Mataials Used i � Test After DC-Closed Clos�Tight � Opmcd at Op�d at nsid Rtpair Tight c �sid csid RP sid The above is catifiod w Fx true. Firm Name ��-ron �i v'e �2os Certified Testc �� �S-Ta.cJ Firm Address �D�'� 7�� Ccrt. Te�ta No. �Da iD�S/ Dace l a /S� �UQ.l�f�2CC L�i/1L ��C Gauge # �//G1D`7� llate last accuracy tested � � CIIECK ONE: iRI�IGATION DOMESTIC FIRELINE X BACKF'LOW PREVENT'ION ASSEMBLY TES?AND MAINTENANCE REP4RT NAME OF PwS: CITY UF' COPPF_LL PWS I.D. # �.oc�TTON oF s�xv�cE: �< <S'. �Po�,a j Thc bac}�low prevcnuon asscmbly detailed beic7v�• has beea testcd and ma�n�a�n� � � bv T!vRvC reguladons and is ccrtificd to be operating w�t�:n a:.�rabie paramctcrs. --�-�Y ��r' .�S�'��LY e Rcduc� Press.�r ?-�a:^i- � Fressure Vacuum Breaku �' Douo:c C�cc��: �+'�d-c = Atmosp�erc Vacuum Breal:tr �, '�iaau:ac~�..�rG �!'�S `::..• ?�4a�d�e: ��� �� �L4� :�c���: JlGI�,� I-� cSLcJ �or�r Sc*.ai '��� /��I75 . s REDUCED P`RFSSCRE PRI'�iCZPLE ASSEviBLk' � PRFSSL1tE �`�CZ'L�MI BREAKER g Doublt C3eck�alvt�biv lst Check 2nd Ch�cl: RelieF Vatve :4ir Inlet C3eck Vah�t ; Ininal Test DC-Closai 3'p Closed Tight +2G' Opcned at Ogen�d at esi� i!� ,; Ti�t � 1 cal:e� � osid nsid 1 �' �.�- ^sid F 2�Ca � , �� i ';.,;�;;cc = � Did not Opca ❑ L,ea}:ed ❑ ; , ; R�a�s � , , i � 's aad ' Masa�ials " � � Usod � Test ARer DC-Closed Closed Tight ❑ Opeacd ai C�Caod ai nsid Repair Tighi ❑ Qsid nsid RP sid The above is c�:tified to be rrue. Firm Name� Gt-io n �i v'e �/�o-S Cettified Tesiet �� �U S-Ta.� Firm Address l"D,��� ��� Cat Testa No. �Oa i0�S f Date %� /5 GU�,�r!�a c-��e 7��c t3auge # �//QC�7� llate last accuracy tested � CitECK ONE: IRRICATION DOMESTIC � FIRELINE BAC.KFT.OW PREVENTION ASSEMBLY TES7'AND MAINTENANCE REPORT NAME OF PWS: C�ITY OF �rOPPf_LI. PWS I.D. # LOCATION OF SERVICE: �/J s . lPa�4 I °Ibc bac}�low preveation asscmbly detailed bcio� has beea trsted and maiataiaed as rcquired b� T!v'?�LC regulacions and is c�rtifiaI co be operating withir� ar,xpcab�e parameters. ��= �� ;4 S��ffiLY c Rcducx Pzessure �..��T:- = Pressure Vacu�Brcakar ,� i?c�uoic �hxk��;�,: = Atmosphcrc Vacuum Breal;a 1f aau�ar�..�� !,c/�f�S ;-.�_ 2�� '�o�:��� o��Nt I ;.��. �P6�°c/bux � �S'�v�ec�- s�� ��� l8572� � REDI;CED PRESSLRE P'RP.�+C�'LE :�SSE'�iBL�' � PRE�L�2E ��ACZ'iJ'wi BRF.�+►F�R a Double Cb�ck Vatve Ass�blv lst Check 2nd C5ec1: Relief Valve 4ir Inlet C'6rck�'ah-t Ininal Tesi DC-Closed 2•� Closed Ti�t ,�Q 4genai at Opened at csi� �I �F Ti�it � I..aal�:� �� �t ❑ nsid nsid � ;3 , '�.�- ^sid ; U � � ;,,-,�;;� _ � Did not Opcn � Lea�:ed � , , � t # aus ; ; aFrd ` ; � Materials ` � Usod � Test ARer DC-Closed Closod Tight o Opeaed at Opca�ed at nsid Rtpair Tia,ht ❑ osid csid RP sid 'I�e above is certified w bc true. Firm Name -�c�-ro� �i v e ��o S Certificd Testa �� /�STa.� Fum Address ��,c��� 7�'� Ccrt Testa No. ,�Dll 1DG�5/ Date l° /S GUa��a �h c� 7`u Gauge � �o//GY�7� Uate last accuracy tested � L CIIECK ONE: IftRICATION DOMESI'IC � FIRELINE BACKFLOW PREVENT'ION ASSEMBLY T'EST AND MAINTENANCE REPORT NAIv� OF PWS: CITY OF COPPF_I_L ?WS I.D. # LOCATION OF SERVICE: �v/I �• �D�4� "Ibe bac}�low prevtntion asscmbly derailcd beiovb �.bs beea tested aad maintaiaod as requir� b� T'v'RCC rcgulaaons and is cerdfied to be aperaang witsin ac:�-prao�e garamete.*s. ""��s �::' .�SE'�iBLY C Reduc�?rrssur ?^..aci�:* _ ?r�ssure Vacuimm Breakrs '� Doueic;��a�:���.��.c - Atmosphcrc Vacuum Brealc '�:iaau:ac�t: ��7�",S '�.�.�� 2�I ?�ic�: '.ti,msia� DD71ti1.� �.� _�: �CIC1�[��X ��J, �S'-�r .P��- s��:�� /9�95� REDGCED PRFSSL1tE PRTtiCIPi.E:�.SSE.�L�' a PR,fS,SL�tE �'�CLt?�i BREr�KER Double C3eck V�Jve Assembly lst C3eck 2nd Checl: Reiief y alve 4ir Inl�t C'6eck�'�1vr �, Ininal Test DC-Closcd 2•Z Closai Ti�t �( Opened at Opcncd at csi^ ! ,, Ti�it .� � I-ca�,;ed C psid osid � `� � �..�- ^sid ' 2'� � p ;�;x = ! Did not Open o L.ea�:od � �� '� ' � �d � ; i U� � Tcst Aftet I?C-Closed Closed Tight o Opeacd as C}pm�d az nsid Rcpair Tighi ❑ �sid �sid RP sid The above is certificd to be true. Firm Name ��-io r] �r r e_ _�l�o-S Certified Tester V fa� �ST a.t1 Firm Address �D,��� ��� Ccrt. Testa Na �'do 106 S/ Dato �° /5 ����a Lh� �� cauge � �Yv/�UD'7� llate last accuracy tested � CIIECK ONE: IRRiGATION DOMESTIC FIRELINE x BACKFLOW PREVENT'IDN ASSEMBLY TEST AND MAINTENANCE R�PORT NAME OF PWS: CI7'�`OF COPPF LL ?WS I.D. # LOCATIOIv' OF SERVICE: G�� �'• /�ava ,[ Thc bac}�low prcvcntion asscmbiy dctailed bciow� has beeu tested aad maintaiaed as rcquuzd bv T"�tR�C regularions aad is c,ertificd to bc opera�ng��it�in a:.cr�ca�ic parametcrs. -�-�� �',� :�S��iBLY c Resiuced a.-�ssurc �^.a.:r:� = Pmsure Vacu�Breaker � ileuoie �'ac:k �"�:•:c � A�nosphere Vacuum BrcaLtr '�i aau:ac^,..�w �Q�ts �;-� ��,� 4ioaci�u�a� 7�7� �i: �l,vP,4-� UP,cc.c �� sc-�i '��cc /D Z lSjo ' REDliC£D PRESSL'RE PRL'�CI�.E :iSSSE.i�iBL�" ; PRE.SSL�t,E `��C�.Z.�K $RF.AKER Double Check�alve�blv lst C3eck 2nd C3ec1: Relief V alve :�ir Inlet C'heck�'a�v� �f Iniaal Test DC-Closod �•2 Closed Tight �1 Opened at Opeaed at esi� �� ! Ti�t � I.cal:.ed 2 $ � �sid osid � ii � �„�. ^szd ; � f :,-ai;� _ ; ; Did not Opeu � Lea�:ed � � ; t �� # ` { ; M� ; 4 Used � Tcst ARer DC-Closed Closed Tight ❑ Openc�at O�ed at osid Rtpair Tight ❑ nsid �sid R.P sid T7ie above is certifiod to be truc. Firm Namc �r�ro n �i re �/Lo S Certifitd Testa VQ�a� ��-T a.� Firm AddrGss �D��� ��� Cert Testa No. �Oa 10�S/ Date ��° /5 ���hQ ��� �� Gauge � �//G1�'7� llate la5t accuracy tested � GIIECK ONE: IR.RIGATION DOMESTIC x FIRELINE BACI{F'LOW PREVENTION ASSEMBLY TES'f AND MAINTENANCE REPUIt? NAN�OF PWS: CI7'Y UF C'OPP�LL PWS I.D. # a.oc�r�or� oF s�v1cE: _ ___��l �5'. iPo�4/ Thc bacl�low prcvcntion asscmbly dccailed beio�c�� �as been trstcd and mainsained as rcquire� bv T'�R4C rcgulaaons aad is certified to bc vperanng uzt��in ar.,..�t,�bie paramrters. �—�-a� r:: .�5�'�iBLY e Reduc.�i Pzessurc :�^.acs i:e � Pressure V aeu�Breaktr � �eubk L��� �'a::�c � Atmosphere Vacuum Breal:er '�izat::ac^.u� .UG��S ��.:-� � � ► �:��o� 007tit/ �.�: /.vP.S� SI� .�h � s���� .� ��o lO � ' REDUCED PRESSL'RE PR['��LE :�.SSE:4iBL�� i FRES5L�+LE �`ACZ'U:4i BRF.r+►KER � Doubie Cbedc v alve Assembfv � lst C3eck 2ad Checl: ReIief V atve :�ir Ialet Cherk�'atvr �f Ininal Test DGClosed 2•Z Closed Ti;ht � Opcned at Opened at esi� !,I i'' Ti�t k� I,calced Z❑ �sid �sid '� j �� a�td ^ , 2' ! =i � .,�,3;;x _ ; Did noc O�ca o L,cal:ed � w s� y t �� jV�3IGl721S ; ' ¢ i Used j Test AR,er DC-Closed Closed Tight ❑ Opeaed as 0�at nsid �� T;� ❑ osid osid RP sid The above is certified tn be�uc. Firm Name �c�-ro r7 �i ve �2o s Certified Tester �t� ;�U S'Ta.tJ Firm Address �D,�'� 7�1'� Cart. Testa No. L'�'OQ iD�S/ Dace �e /S Glia��a G�� �'u c$uge # �o//G��7� llate last accuracy tested � � C�IECK ONE: IRRIGATION DOMESTIC S(' FIRELINE sAc�,ow Px�vErrrioN�ss�LY�s�r ax��►nvrErurjaE�oR�r NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �/I �S'• �0�4 � Thc bacicflow prevcation asscmbly decailod below has been tested and main at� � nq�� �y 'I'�p��� re_guladons and is cerdfied to bc operating within accepcable parameters. TVPE OF ASSE:vlBLY c Rcduc�Pmsure Prinrinle _ Pressure Vac�nmm Breaker � Doubic Cha,I�Val�c � Atmosphere Vacuum Br�ealaer �� �.U�-�S s:� 2,� �z�,�� 6U7M 2 �.a: u��s� �� �P����x s��+� D S��`Z/ REDi3CED PRFSSU'RE PRl'�C�Pi.E ASSE.'1�LY � �R£S5i.7tE'�Af.WM BREAKER Doub(e Chedc Valve Assemblv lst C3eck 2nd Checl: ReIief Valve :�ir Inlet C6eck��+� Iniaal Tesi DGClosed 2•D Closed Ti,ht � Opened at Opened at �sid Ti�t 24 Leal:ed ❑ nsid �sid R°-_psid Z•2 I,cai:ed c Did not Opea o Leal;ed D Re�aa� aad Materiats Used Test ARer DC-Closed Closed Tight o Opeacd at Opmed at _,,�sid Rtpair Tight ❑ �sid RP sid The above is cerdfiod to be�ue. Firm Name ��ron �i v.e �/�o-S CertiSed Tester ✓IJ`o� �UST�.cJ Firm Address �D�`� 7�'� Cert. Testa No. �D(J/D�S/ Date l� /5 GUa�ha c-�ce 7'�c Gauge � �//OO'75 llate last accuracy tested��_ CIIECK ONE: IR.RIGATION DOMESTIC FIRELINE X BAC�'LOW PREVENTION ASSEMBLY TES'I'AND MAINTENANCE REPORT NAME OF PWS: C`ITY OF COPPFI_L PWS I.D. # LOCATION OF SERVICE: �o II c4. �•aG � I�c bac}�low prcvcndon asscmbiy detailed be'saw� taa�� beea trsted and IDaintain� � � �v T?vRuC re2uladons and is ccrtified to bc operating��th:n a:,x�saaic parametcrs. °�-p� �'� .�SE'�iBLY c R�ducrd ?msur- ?-�:�:^:c = Pressure Vacuum Breakrr ,� Dcuai: ��c�"r:t'�.`°•;: � Atmosphere Vacuum Brea�er '�xa.auiacr,�- /.L.L-��S �:�.- 3��ii Msocicc:'�:�zs't� 007/�t 2 ��: /,v+oS� UCrcc f�- ScF u'.'�c��c D�(o Z/ REDtiCED PRFSSL'�tE PRL"r'+�i.E:�.S.SE."►�BL�� � PRESSLFtE ��:�CL�M BRF.�KER , Doub{e Cbeck Vslve Assembiv lst Check 2nd Checl: Reiief y alve 4ir Initt Chetk'�'alx� Ininal Test DC-Closcd 2•� Closed Ti;ht � Optaed at Opcned at asi� �� Ti�: ..� I�calcui 2 � ❑ psid osid f ' R.�- ^sid � � € ;�;3;;� � � Did not Opcn c I,ea};ed ❑ � � t f � �� ` ; , Matesials � ' � Uscd { Tcst ARer DC-Closed Closed Tight o Opeacd at C)peaod at nsid Rcpair Tight ❑ osid �sid R.P sid The above is ccrti:fied w bc truc. Fitm Name :��io n �r v e �2o S Catified Testcr �� �'U�'T a.tJ _ Firm Address �D,�`� �g'� Cert Testa No. ,�Oa iD�5% Date j e /S. ���ha ��� �� Gauge # �`//OD'7� Date last accuracy tested �