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2014_0909 C�IECK ONE: IRRIGATION DOMESTIC � FIRELINE BACKFT�OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # �� LOCATION OF SERVICE: �' �� -�` ��' �/,� � The bacl�low prevmtion asscmbly detailed below has beea testod aad ma�nta�n� � nq�� bv TNRCC reguladons and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY e Reducrd Pressure Principle e Pressure Vacui�Breaker '� Doublc Chcck Valve � Amiosphere Vacuum Breaker l/ U�',� �� ` 3 Manufact�er � Siu Modei Ivt�ber �� Located At �?-�� - �'''''`, 1�'��'�� " :��o; P.7'� s��N�ba 1 3 / � � � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly r�f' i ' lst Checl: lnd Checi: Relief Valve Air Inlet Checic Valve Initial Test DGClosedr C� Closed Ti�t o Opened at Opeaed at osid Ti�t ❑ Leal:ed � nsid osid RP-_psid � � Leal;ed � Did not Opea 0 Leal:ed o �P� and Materials Used Test Af3,er DC-Closed Closed Tight o Opened ai Opeaed at _�sid Repair Tight ❑ nsid osid R.P sid The above is certified to be truc. � �� /ivt t Cercifiod Testa <�t. yc Gv,Il��iu a Firm Name c �/'s- Firm Address ��'•��'f 7`� 7 G{/,��ia TX Cert. Tester No. �3r�o�c�i o.:- D� `7 - i -/ Gauge # 4 l��!/ 7`r L' Date last accuracy tested �-/ 7-� �� White - Customer's Copy Yellow - City Copy Pink -Tester's Copy , � � �"�� C�IECK ONE: IR.RIGATION � DOMESTIC FIRELINE � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT rra,iv�OF Pws: CITY OF COPPELL PWS I.D.# LOCATTON OF SERVICE: �-� '�� r' i"� � 3� f� J The bacl�low prevmtion assembly detailed below has beea tested and maintained as required by TNRCC reguladons and is certified to be operaring withia acr,eptable paramtters. TYPE OF ASSEMBLY C Reduced Pressune Principle C Pressure Vacui�Breaker � Double Chcck Valve ❑ Amnosphere Vacuum Breaker _ _ _ - -- . _ _ -- -- �. _ _ . ._ . - - -__ - _ _ i Manufact�er � ,�� Siu A Model Ivimiber � , Located At % - � � ��`'� �'`-- Serial Nimmber Ci r` . REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check Valve Assembly � lst Check �nd Checl: Reiief Valve Air Inlet Check Valve ° Inival Test DGClosed Closed Ti;ht m Opened at Opened at nsid Tight ^' �� Leal:ed ,:�' � ❑ nsid __nsid R.P-_psid Leal:ed o Did aot Opea O Leal;ed O � . � r--� , f �� l au�s ' r . � , . - . . .. � , , aad ,� , , � ; Materials Usod Test Af�r DC-Closed Closed Tight o Opeaed at ppeaed at �sid Repair Tight 0 Dsid osid RP sid The above is cerdfied to be true. , ; . : Fi:m Name r/;- t- .> ,.� , , �� c, Certified Tester , .: �; <. , f;,,�£ -; a . � , , ,- Firm Address � . f, � '� i�> �` � Cat Testc No. �; � <� , . -�� ; � ,� r- �.c. , r ;�� , x Gauge # , :; { .: i � ✓ ; r.m llate last accuracy tested - / '' ` ��f White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION � DOMESTIC FIRELINE BACI4T�OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: ��'��I �� n a %�� The bacl�low praveation asscmbly decailed below has bxa tested aad maintain� � nq�� bv 'INRCC re¢uladons and is certi5ed to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reducrd Pressure Principle C Pressur�Vacu�Breaker �', Doublc Chxk Valve �7 Atmosphere Vacuum Breaker � � � �r Maaufacturer �� '�'�� Sizc Model Number `� �� Locatcd At ��- /3G � /�� 'zr�'�� '�� Sezial Nimmber �� '� / '�. REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R � � �, � Doubie Check Valv�Assembly � �. ; lst Cherk 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGCloscd � Closed Tight o Opened at Opened at esid Tighc ` ❑ Leal:cd � ./�. osid osid RP-_psid � �;� 1g�, Did not Opca o Leal:ed � �P� aad Materials Used Test After DGClosed Closed Tight ❑ Opened at Opened at �sid Rtpair Tight ❑ nsid osid RP sid The above is certified to be tzue. Firm Name��'�'°�v i'�K r Certifi�Tcsta ,'��!��G /�/, ��i�� Firm Addrc.ss �� "y � `e � (,U,��,,g - ��Cat Tester Na /3f?pG��7�� Date �_ � _��e Gauge # �G o `�/ 7 Y� llate last accuracy tested 3 '�� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE � BACICFT�OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAIv�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: �' �� '� '��"`� � �"" f " � 'Ibe bacl�low przveation asscmbly detailed below has beea tested aad ma�nta�n� � requii�ed by TNRCC re�ularions and is cerdfied to be operating withia acceptable paramcters. TYPE OF ASSEMBLY e Reduced Pressure Principle e Pressurc Vacu�Breakcr �V Double Check Valve a Atmosphere Vacuum Breal:er Manufact�er ��'�� s" !� Siu ��i�` Model Number �� L Located At ��'! j,✓,��U �'� Serial N�ber 1/ � `�'� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�C[J�JM BREAKER Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Checic Valve Inidal Test DGClosed � Closed Tight � Opened at Opened at esid Tidit � Lcal:cd �� o nsid osid R.P-_psid �� p Did not Opea o Leal:e� ❑ �� aad Materials Used Test Aft;er DC-Closed Closed Tight o Opened at Opeaed at �sid Repair Tighi � vsid osid Rp sid The above is certifiod w be�ue. Firm Name f�c�o��- r l�'t � Cerdfied Testc >��/�``� G�� I��+�� S' FirmAddress��' l�c>�c 7�7 G�'�Y�-r� Cat TeswNo. �r�GaOD�77G9= Date �1= Gauge # C� C?Q `/I � �Z� Date last accuracy tested �"�7 �y White- Customer's Copy Yellow - City Copy Pink-Tester's Copy CHECK ONE: IRRIGATION DOMESTIC x FIRELINE BACICF'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT x�oF Pws: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE: � �� 5- �d i��9 � The bacl�low prevmtion asscmbly detaile� below has beca tested aud ma�nta�n� � nq�� bv TNRCC regulations aad is certified to be operating within acceptablc parameters. TYPE OF ASSEMBLY C Rtduced Pressure Principle ❑ Pressure Vacu�Breaker �. Double Chcck Valve � Atmosphere Vacuum Breaker Manufacturer w� � � 5 Siu � ,' Model Ivumber � �' � �1" � Locaud At /� �7'��t Scrial N�ber � � 7 y s � REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Cherk v alve Assembly lst Check 2nd Checi: Relief Vatve Air Inlet Check Valve Inival Test DGCloscd �' Closed Ti� t � Opened at Opened at nsid Tight �1 Leal:ed r'� ❑ �sid _osid RP-_psid �;� o Did not Opea o I,eake� � �P� and Materials Used Test Aftet DC-Closed Closed Tight o Opeaed at Opmod at �sid Repair Tight o �sid osid R.P sid The above is cerdfiod to be tive. Firm Name �� T��'ti� �� Certifiod Tcsta �� "` l.� //'r�� Firm AddRss � �./3 c;r 7� 7 l�'��x�-T�` Cac. Tcster No.��a�co ra.�- D� �f'-�-��j (Gauge # O(�D�//7�� llate last accuracy tested 3 �� 7� � � .� r: _ White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION�_ DOMESTIC FIRELINE BACKFI.OW PREVENTION ASSEMBLY TES?AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATTON OF SERVICE: � �� /'� ° �!� � � The bacl�low preveation assembly detailed below has beea tested aad mainta�n� � nq� �, 'I'N�tCC regulauons aad is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C Reduced Pressurc Principle C Pressvrc Vacu�Breaker ,�. Double Check VaIve a Amiosphere Vacuum Breaker Maaufacturer �J�'l4 f �5 Siu � Model Number � � 7� / Locat�d At /�'l e��k s��N�ba 1 � 5 ��Y �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CLTUM BREAKER Double Check Valv�Assembly lst Check 2nd Checl: Relief Valve :�ir Inlet Check Valve Inidal Test DGClosed �� Closed Ti� t h9 Opened at Opened at _nsid Tidit ,�I Leal:ed � o nsid _osid R.P-_psid LcaI:ed � Did not Opea o Leal:ed � �P� aad Materials Usod Test ARer DGClosed Closod Tight o Opeaed at ppeaed at __nsid Repair Tighi ❑ nsid osid R.P sid The above is certi6od to be true. Firm Name �1�� f�� T Certified Testa i�f l`�- G�` 1/��F" s Firm Addc+ess �d.��'°� 7 r � l��xA-i� Ceri. Tester No. �Po�oo 7�.�- Dace -�I_f-i% (�auge # �C�f,��1> ��Z�' llate last accuracy tested � -� � �� White- Customer's Copy Yellow - City Copy Pink-Tester's Copy