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2015_0817 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 h �� 7,SQ�� CONTACT PERSON/PHONE: J - • 7 LOCATION OF SERVICE: � �-�� The backflow prevention assembly detailed below has een tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �Reduced Pressure Principle I iReduced Pressure Principle-Detector �'Double Check Valve D�Double Check-Detector �PressureVacuumBreaker ClSpill-Resistant Pressure Vacuum Breaker Manufacturer Av�es Model Number �Q�- �,� Size y�� Located At ��sev I�oo;,� f-1 Serial Number � I - U30�7 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e5 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 �.6 psid Held at�_psid Opened at Opened at Held at InitialTest ClosedTightDQ ClosedTight �C psid psid psid Leaked�] Leakedl �' Did not open I 1 Did not open I Leakedl��I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight L I Closed Tight f 1 psid psid psid Test gauge used: Make/Model C�;�bvd�o �/Q -�OC)- rl�/� sN: 33176� Date Tested for Accuracy: 4/9,/a015 Remarks: The above is certified to be true at the rime of testing. FirmName/�u�,,�,� .7.nv�n��vs Firm Address lU57S I��s�i� l�ar� �.�. 1��i,s T�C 75�3� Certified Tester(pr:nt) t��a$��rJ� Certified Tester(signature) �3aoo�a6�3 Firm Phone# aI�l-,34q-a��I Cert.TesterNo. �7,�-51�1-�1.35�� Date ��J7/a0l5 * 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS 1.D. #0570040 (Customer) MAILING ADDRESS: / I % , d CONTACT PERSON/PHONE: /�� '� / - 7- 7 LOCATION OF SERVICE: � ,. - c 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 �Reduced Pressure Principle-Detectar �QDouble Check Valve I Double Check-Detector -7PressureVacuumBreaker 'Spill-Resistant Pressure Vacuum Breaker Manufacturer �i�e� Model Number �Q(�d�/�0�� Size 3/� �� Located At�iSev ��i� � Serial Number Q,3 7�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �S 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,3.o� psid Opened at Opened at Held at Initial Test Closed Tight?G Closed Tight ,�' psid psid psid Leakedf 1 Leaked� Did not open I I Did not open f 1 Leakedf Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight 1 ClosedTight I psid psid psid Test gauge used: Make/Model �,,;,,�,.,��a t/Q-o?0t'�- �J� SN: ;�,�� 7(g Date Tested for Accuracy: y/�1/a0/5 Remarks: The above is certified to be true at the time of testing. FirmName �r�-��,�,� .S„�,�N��vs Firm Address /0�7�i V S�n 1��,�k R�l Dallus TX 75�3� Certified Tester(pr:nt)�J,�:;�,�,� �,,, � Certified Tester(signature) ,.� �3l�Qo>ad�� Firm Phone#,�l�I-3�,!9-a��?l Cert.Tester No. 97��5%�l-9��3 Date $��7��Df_-�i * 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) MAILING ADDRESS: / � l �� I k�' . �X 7 I CONTACT PERSON/PHONE: I 'I , - 77 LOCATION OF SERVICE: ,, �} 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 i'Reduced Pressure Principle :'Reduced Pressure Principle-Detector [�Double Check Valve �Double Check-Detector 1PressureVacuumBreaker ISpi11-Resistant Pressure Vacuum Breaker Manufacturer /-tyv�e_5 Model Number�OQU - �� Size fi •, Located At ��,sev ��o:�-r � Serial Number F�- Q��S Is the assembly installed in accordance with manufacturer recommendations and/or local codes? }��s 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 �. g psid Held at,��psid Opened at Opened at Held at Initial Test Closed Tight� ClosedTight I�d psid psid psid Leaked. I Leakedf I Did not open 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' 1 ClosedTight�I psid psid psid Test gauge used: Make/Model C�;��,vdc� �/� ��l D - /l�/� SN: ,��I 76� Date Tested for Accuracy: _�/�4/�QJS Remarks: The above is certified to be true at the time of testing. FirmName ��,,,�n� ,��;,,�K��ys Firm Address �Q.57� ��5�-Q ��,,,� ,(�� ,��,s �� 7�i,�3� Certified Tester(pr:nt)�s�ua �,�:.r,r�s��. Certified Tester(signature) �3�O�i�6�3 Firm Phone#_�lU-3�19-��a/ Cert.TesterNo. q7��%�/�G�3��S�Date $/17.��a1� * 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 I.D. #0570040 (Customer) MAILiNG ADDRESS: / -] CONTACT PERSON/PHONE: 1� �ch / - - 7- �78 ' LOCATION OF SERVICE: ; 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 .-1Reduced Pressure Principle f;�Reduced Pressure Principle-Detector LfQDoubleCheckValve �1Double Check-Detector �;PressureVacuumBreaker i Spill-Resistant Pressure Vacuum Breaker Manufacturer��„��0 5 Model Number o��(1(�,Q/I/J_� Size �/t� " Located At ��s�v �aowt 13 Serial Number O�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Y s 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 r.a psid Opened at Opened at Held at Initial Test Closed Tightl5d' Closed Tight � psid psid psid Leaked. 1 Leaked J Did not open 1 Did not open I�I Leaked '�. Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ' ClosedTight❑ ClosedTight�I psid psid psid Test gauge used: Make/Model �,,,,1,.��C�, yo-��n-TKD SN: ,�_�f �]h g Date Tested for Accuracy: �1,�9./�D/5 Remarks: The above is certified to be true at the time of testing. FirmName M�n�Nn� �h,,;„��Pv7 Firm AddresslO��j �/,�4�0, �e�v� �,� Qe��,�� 0�-3� Certified Tester(pr�nt) , - ti�, � �, � Certified Tester(signature) „� �31�OD1�6/3 Firm Phone# �I C/-3�ILI-a��l Cert.Tester No. 17a-5'1U-93d 3 Date g'�17.��0l5 * 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 I.D. #0570040 (Customer) MAILING ADDRESS: / L 12 . 7 CONTACT PERSON/PHONE: /1/J � - - LOCATION OF SERVICE: r� ' A� 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 f_7Reduced Pressure Principle-Detector Ci Double Check Valve �Double Check-Detector I��PressureVacuumBreaker `7Spill-Resistant Pressure Vacuum Breaker Manufacturer �v►�c5 Model Number �O(��, - (�� Size ��_ Located At �ise� �vo�v+ � Serial Number %��-�3�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �rs 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)d Closed Tight � psid psid psid Leaked.l Leaked� I Did not open ! Did not open I I Leakedl Repairs/ Materials Used HeLd at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight L7 ClosedTight I �� psid psid psid Test gauge used: Make/Model C,,,��,,,�ca ��Q-�0� -Ti�U SN: 3�J 7�� Date Tested for Accuracy: yeq./�?Qi,S Remarks: The above is certified to be true at the time of testing. FirmName �u�rno�� Se�,hk��✓5 Firm Address fQ57�j U�s�a ��,v�C �c�. �e��Us. � 75.�_3S Certified Tester(print) Ur�s�ti�. �i�,ti,v�suv► Certified Tester(signature) _ j�f�QQ1�6� Firm Phone# �I U-3 zl9 -o?a�1 Cert.Tester�10. 97�-5lzl-�I3��ate 8/i�7/a0/5 * 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 I.D. #0570040 (Customer) MAILING ADDRESS: /�Q� _ ��„ �.,�cP Rl � e//i T)( 7��/Cj CONTACT PERSON/PHONE: J� /V� N C/, 7_ LOCATION OF SERVICE: 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 ]Reduced Pressure Principle � 'Reduced Pressure Principle-Detector �DoubleCheckValve ` IDouble Check-Detector -IPressureVacuumBreaker I Spill-Resistant Pressure Vacuum Breaker Manufacturer��,v��s Mode] Number Q(��/�3 Size �/�� " Located At ��rse✓ ��tiwi Serial Number Q�Q�i9 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ��s 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 Tightl 1 Closed Tight 17 psid psid psid Leaked�i Leakedl-1 Did not open I 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 Closed Tight C� Closed Tight f.�� psid psid psid Test gauge used: Make/Model�a�,��Q �/(1-aQQ- TK/� SN: �,�/ 7�� Date Tested for Accuracy: � �/ Remarks: ^ � v �. , � � �� . � �� The above is certified to be true at the time of testing. Firm Name�� `S„�,:h��Lvs Firm Address /Q�"7 L;s��,, %��,✓�C ��.� l �ll,s 77l 75a3S Certified Tester(pr:nt) �� Certified Tester(signature) �� ,(3/�Qd��6/ Firm Phone# �/L/.,3�19-��1 Cert.Tester No. .(I7.�-.5/�l- �I3fS3 Date S/>�,�aa� * 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 X 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) MAILING ADDRESS: h L 7 /CJ CONTACT PERSON/PHONE: / - q . 7 LOCATION OF SERVICE: The backflow prevention assembly detailed below has een tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY JReduced Pressure Principle I 7Reduced Pressure Principle-Detector �DoubleCheckValve ]Double Check-Detector �PressureVacuumBreaker �]Spill-Resistant Pressure Vacuum Breaker Manufacturer I�ua��s Model Number �L Qo�l�/��Q� Size -3�� Located At �isc✓ ��o�vh C Serial Number �3 S'y53 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Y�� 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 TightL�4 Closed Tight �� psid psid psid Leaked.l Leakedf I Did not open I 1 Did not open � I Leakedl�I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight L psid psid psid Test gauge used: Make/Model ��;�br,��d yQ-a�-Ti(�/� sN: 33/76� Date Tested for Accuracy: �/ 4 / Remarks: � al i h . Oa 06q l� �'C/�l0 IV��u. v a��`ha ' U04001 The above is certified to be true at the rime of testing. FirmName ,ML�}�n�,� Snve��vn Firm Address �Q�7,5 V�"s� �� . �e�/�qs� �� 7J��,3� Certified Tester(pr:nt) � � s � Certified Tester(signature) � Firm Phone# ��j�Q-��,,?/ Cert.Tester No. ,(�l�Ddl�� Date �/j /aDjS * 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