The URL can be used to link to this page

2015_1013 IRRIGATION DOMESTIC � FIRELINE The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: I�b� �RA�►J(��,E� Ci(� �Pp�i..l ��C CONTACT PERSON/PHONE: Lov�iS 11'�RC�i�S LOCATION OF SERVICE: 4bo C��IJ � The backflow prevention 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 I 1 Reduced Pressure Principle :�Reduced Pressure Principle-Detectar I�Double Check Valve I� I Double Check-Detector �PressureVacuumBreaker �r-Spil1-Resistant Pressure Vacuum Breaker �i Manufacturer��'T'S Model Number�D7 /�'� 1 � Size� Located At ��-'�'-'�l�E A L�%E /iVE��0 1��E Serial Number 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 1 st Check 2nd Check Held at �� psid Held at �� psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight KI' psid psid psid Leaked� 1 Leaked .l Did not open I � Did not open f l Leaked I � Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight'_� Closed Tight'�_.i psid psid psid Testgaugeused: Make/Model�mBRt�co �0� �� - SN: Z�� Date Tested for Accuracy: ��r.s Remarks: The above is certified to be true at the time of testing. FirmName`�"�`��' ��D Firm Address �� wR��'�� ' Certified Tester(prPnt)��►V��-� Certified Tester(signature) � Firm Phone# �"' �"F 1�'8 d�0 Cert.Tester No.��75� Date �� j3 �S * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-Ciry Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION�_ DOMESTIC FIRELINE The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. #0570040 (Customer) MAILINGADDRESS: I7JO�J W�A�� 'R. CONTACT PERSON/PHONE:LO11�\S (`(�RCQ�� Z� —4�f� �- �l��V LOCATION OF SERVICE: �oD w �/' C-oM �� The backflow prevention 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 C:Reduced Pressure Principle I 'Reduced Pressure Principle-Detector �DoubleCheckValve IDouble Check-Detector i�lPressureVacuumBreaker ��Spill-Resistant Pressure Vacuum Breaker � �� Manufacturer Fe:�co Model Number g� b Size �- # � 0�37n Located At(�� `�� Serial Number Is the assembly installed in accord nce 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 1 st Check 2nd Check Held at I�� psid Held at �� psid Opened at Opened at Held at Initial Test Closed Tight��4 Closed Tight� psid psid psid Leaked' i Leaked� I Did not open � � Did not open f.�1 Leaked� �� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight i7 ClosedTight i J psid psid psid Test gauge used: Make/Model �/n8�1�O '�b ��200 �G SN: %�5$bD� Date Tested for Accuracy: ��$� f sr Remarks: The above is certified to be true at the time of testing. FirmName �P��L s� Firm Address �3�w�1'�9'�e�" (_-s��I'"• �'PP�f �� t Certified Tester � CertifiedTester(pr:nt) V1� �� (signature) Firm Phone# Z�� "u 1�Y�� Cert.Tester No.�P��D�O1�j�j Date �d �3 �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 IRRIGATION k DOMESTIC FIRELINE The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: ��03 ��ANG LC-R G�Q, CONTACT PERSON/PHONE:�.aUl'S (hI�1�-A's-`� �I�}-�{ 'b•-804C� LOCATION OF SERVICE: �v0 �% o�/ Cor►'1 p e.y The backflow prevention 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 C:Reduced Pressure Principle :1Reduced Pressure Principle-Detector CiDoubleCheckValve �� 'Double Check-Detectar ❑PressureVacuumBreaker ��Spill-Resistant Pressure Vacuum Breaker Manufacturer FtFJ c�V � Model Number ��ru Size �'' '� 3 Located At'�u<C—i �iPrfc. J �j Serial Number � �� ] 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 1 st Check 2nd Check Held at �o� psid Held at �'� psid Opened at Opened at Held at Initial Test Closed Tightf7'�"r Closed Tight'b4 psid psid psid Leakedl � Leaked' I Did not open �� Did not open f�' Leaked �I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at . Repair ClosedTight'1 ClosedTight L' psid psid psid Test gauge used: Make/Model�� ' ��- SN: 'L�$ODO Date Tested for Accuracy: '��1�/�1 l5 Remarks: The above is certified to be true at the time of testing. FirmName��(J�� I ��D Firm Address ��3��(I'� ��'. �I�(�� Certified Tester(pr:nt) ��d �� 'eiI Certified Tester(signature) r,r,�� . Firm Phone# �� '" � I`' �gO�� Cert.Tester No. �p�b67�D Date �b/ �3/�s� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-Ciry Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION� DOMESTIC fIRELINE The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: (30 j �ql��(Z C�R� C.c�PP�(1-'�C�C �7�v01�'t CONTACT PERSON/PHONE:�-OU(S M A(�'R�+S Z%4- `f�F`—FSo'�U LOCATION OF SERVICE: �Ob COK� Co�vl P� The backflow prevention 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 � iReduced Pressure Principle ��r�Reduced Pressure Principle-Detector �DoubleCheckValve I��Double Check-Detector �1PressureVacuumBreaker 1-Spill-Resistant Pressure Vacuum Breaker Manufacturer ��Cb Model Number �S U Size Z�� Located At�'�e-�-�� G��E 1 �� Serial Number � ��3�� Is the assembly installed in accordance with manufacturer recommendations and/ar local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at Z�0 psid Held at �b psid Opened at Opened at Held at Initial Test Closed TightrJ� Closed Tight � psid psid psid Leaked��1 Leakedl� Did not open f Did not open f 1 Leaked� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight I-! ClosedTight'��I psid psid psid Test gauge used: Make/Mode1C oM�RC,O ��''�� SN: �Sb0[� Date Tested for Accuracy: � � � � �� Remarks: The above is certified to be true at the time of testing. FirmName��P^�-�— s S� Firm Address ��0� �(l�(�'�IV(��f.� C-i2• Certified Tester(print)D�V'—�•-p �� Certified Tester(signature) � � Firm Phone#�� ' 7-I �� Cert.Tester No.��d��g Date�� * 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 J�C DOMESTIC FIRELINE The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) /, 1 /I MAILING ADDRESS: �3a Wrd�'t rf'✓ �rt.� C� � � '1j�'Q�g CONTACT PERSON/PHONE: f ` LOCATiON OF SERVICE: 4�OD uJ o�/ wr1 pl�y The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is cerrified to be operating within acceptable parameters. TYPE OF ASSEMBLY �Reduced Pressure Principle �:Reduced Pressure Principle-Detector 1�Double Check Valve C1 Double Check-Detector � IPressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker .- �i Manufacturer �� LU Model Number � S � Size z� � Located At�'�-�-`� �R�"(� I � �o1�1-I Serial Number � �� 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 1 st Check 2nd Check Held at �+d psid Held at Z�� psid Opened at Opened at Held at Initial Test Closed Tigh� Closed Tight`b� psid psid psid Leaked. 1 Leaked�1 Did not open _1 Did not open I Leaked 1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight'7 ClosedTight�I psid psid psid Test gauge used: Make/Model �►�'�brlj.Ct� ��' �b� j IG SN. Z��OOU Date Tested for Accuracy: _�1/� I S Remarks: The above is certified to be true at the time of testing. �� , FirmName��(-�C.'I I -�- S D Firm Address i 3�3 Wfan �� ' �r Certified Tester(pr:nt) �f�U 1(�1��'Q Certified Tester(signature) Firm Phone# Z��-�Q�'��{� Cert.TesterNo.��0�0l07$� Date �n � ( * 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 k DOMESTIC FIRELINE The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � /� /� / ,��Q MAILING ADDRESS: ��03 ��il'� ��r l..i"��G�C C� � ��/1�7� l CONTACT PERSON/PHONE: /' �%G'S LOCATION OF SERVICE: DD � uJ O �vri'1 t The backflow prevention 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 C1 Reduced Pressure Principle f Reduced Pressure Principle-Detector [�Kbouble Check Valve ❑Double Check-Detectar '--1PressureVacuumBreaker ' ISpill-Resistant Pressure Vacuum Breaker r r- f� Manufacturer rG�LO Model Number �� Size z '�- !�D 7 3�g Located At ��G-�' �f17� �- ND � Serial Number Is the assembly installed in acco dance 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 1 st Check� � 2nd Check' � Held at �i�psid Held at Z�� psid Opened at Opened at Held at - Initial Test Closed Tightl}( ClosedTight�l psid psid psid Leakedf 1 Leakedf�� Did not open f I Did not open . I Leakedl I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight I I ClosedTight I �� psid psid psid Test gauge used: Make/Model LDM��Q rd �� SN: �-s�Q b0 Date Tested for Accuracy: Q � �S� Remarks: The above is certified to be true at the time of tesring. FirmName oe/I �-S U Firm Address �� TQ �'' �/'a Certified Tester(print) ` ,� �� Certified Tester(signature) � � Firm Phone# ��7 'T ((r`Z7�7�a Cert. Tester No.��7sg Date �� 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 IRRIGATION �` DOMESTIC FIRELINE The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) 1 MAILING ADDRESS: � 3 03 �'`��ah 1'� ��" �OP �� 75�� CONTACT PERSON/PHONE: L � 'u5 d LOCATION OF SERVICE: �f D�fl (�� uJ a..� m 3�"� The backflow prevention 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 i Reduced Pressure Principle f Reduced Pressure Principle-Detector �Double Check Valve 'Double Check-Detector i�Pressure V acuum Breaker :�I Spill-Resistant Pressure V acuum Breaker Manufacturer ��G f� Model Number O �^C� Size Z�� <<� G�� `� � a73��1 Located At � � � Serial Number 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 1 st Check 2nd Check Held at ��3 psid Held at �'� psid Opened at Opened at Held at Initial Test Closed Tight�l.' Closed Tight f7�' psid psid psid Leaked'�� I Leaked�.l Did not open i Did not open f' Leaked� � Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tigbt f� Closed Tight I I psid psid psid Test gauge used: Make/Model `-o M 6`a��^ ��` �'�0 T r� SN: Z�$DG�U Date Tested for Accuracy: /�(� /s Remarks: The above is certified to be true at the time of testing. Firm Name `��j��i L s� Firm Address O�J �/r4 lt�I' ",r �,/ � � Certified Tester(pr�nt)�Q U��CI �a r �B� Certified Tester(signature) Firm Phone#��—�9�'"77��d Cert.TesterNo.,�/ ��S�Date �� /.3 �✓�'� * 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