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2015_0922 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: S�� l�Y �n � 71� ��e/ �t�Gc �SCJ /9 CONTACT PERSON/PHONE:__�� S 7�_�lJ� G'�Cj U�� 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 I-iRe uced Pressure Principle I 1Reduced Pressure Principle-Detector � ouble Check Valve I Double Check-Detector ' 1PressureVacuumBreaker -1Spi11-Resistant Pressure Vacuum Breaker ^-� �� Manufacturer � G'i �S Model Number (�� /�l Size�_ Located At Y r�C �' �Q�l�i� I� �. 7 Serial Number �p�� . 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 L Held a �psid Held a��psid Opened at Opened at Held at lnitial Test Closed Tightf%� Closed Tight I� psid psid psid Leakedf I Leaked'�..1 Did not open .�1 Did not open .�1 Leaked I��I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight_ I Closed Tight C7 psid psid psid Test gauge used: Make/Model ' `�✓�',f��y.5 - SN:C��U�/(`j �� Date Tested for Accuracy: �/�/s �S Remarks: The above is certified to be true at the time of testing. FirmName ��'��6 �!//Yf1''I Firm Address d� Z� �s ' " G ��0 Certified Tester(print)��rr y �C�a� Certified Tester(signature Firm Phone#�7��'�Q�� Cert.Tester No��l1�`�� 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 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: ��,�Yi�1� I 7�7L-��,f�I�y�G �c/t ��1 g CONTACT PERSON/PHONE:��,��7,��l��( LOCATION OF SERVICE: ��e 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 :7Reduced Pressure Principle-Detector ��ouble Check Valve �Double Check-Detector "'PressureVacuumBreaker 7Spi11-Resistant Pressure Vacuum Breaker Manufacturer l,�L�f�� Model Number �f�' �/�'t � Size� Located At�'��i�''1� �Qa�1'J ��, "� � Serial Number �J(�1 � � T 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 TightW Closed Tight � psid psid psid Leakedl I Leakedl_1 Did not open f� Did not open [ I Leaked�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight[� Closed Tight i I psid psid psid Test gauge used: Make/Model /�'//�(ef h/P,��y�'�� SN: �`�U�'L��S'G� Date Tested for Accuracy: ��f��j.� Remarks: The above is certified to be true at the time of testing. FirmName/�/��I� ��h�111� Firm Address �I' C iJt� a�/r G/ � Certified Tester(pr�nt�EY Certified Tester(signature) �C� FirmPhone#�� 7UG' Cert.TesterNo��(�Lfl�� 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 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�r �"�, f�/7 �. ��f'l h c/p� 7S�J�S' CONTACT PERSON/PHONE:��n� �_ �7� �UG fJDUC� LOCATION OF SERVICE: S'�� 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-Detectar �oubleCheckValve f�'Double Check-Detectar � 1PressureVacuumBreaker �Spill-ResistantPressure Vacuum Breaker !! Manufacturer �5 Model Number �Ca � / Size�_ Located At y' ��1� Y'D Of'� �J��i �0 Serial Number �' ��y Is the assembly installed in accordance with manufacturer recommendations and/or loca] codes?��G�' 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�ppsid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight� psid psid psid Leakedl I Leaked' I Did not open I Did not open ��` '� Leaked'��1 Repairs/ Material s Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight f. Closed Tight� I psid psid psid Test gauge used: Make/Model ` . l� � `' SN:�`IT O�/Q �(�''� Date Tested for Accuracy: � S�� Remarks: The above is certified to be true at the time of testing. Firm Name,��r�� Cf1�'1 1s'� Firm Address � j�� ?'f � % Certified Tester(print)� Certified Tester(signature7-- Firm Phone#�� O �G� � Cert.Tester Na � (� 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 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 far recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. #0570040 (Customer) ,� / MAILING ADDRESS: �S j�, �t�r � J� /�/? L�fj'c��`�r h� �Gf 7�Q/1"� CONTACT PERSON/PHONE: � r,c r', `-/�Z,� �''Li`� (�D .�'�'i� LOCATION OF SERVICE: ��n•, � 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 r Reduced Pressure Principle-Detector �uble Check Valve C Double Check-Detector ❑Pressure VacuumBreaker �Spill-Resistant Pressure Vacuum Breaker /! Manufacturer � �v'ff� Model Number �� Size � Located At ��Er ,�'Cl 0�'I /J!� ��/� Serial Number �(L� 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 lnitial Test Closed Tight+i� Closed Tight J� psid psid psid Leaked.�1 Leaked.�l Did not open �I Did not open I�� Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�J ClosedTight'��I psid psid psid Test gauge used: Make/Model �� ,5�� SN:I3�LJ��Q�f� � Date Tested for Accuracy: /�/f f/s Remarks: The above is certified to be true at the time of testing. Firm Name�C �Y'v ��+R/✓1, Firm Address��/j' I,ZC��(°rr��e�!�h c��,�� y f` Certified Tester(pr:nt�c�� Certified Tester(signatur ��- �� Firm Phone# 7��2� �� Cert Tester No�ld'U0� ��f' Date��.2�- �-� * 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) MAILING ADDRESS: �' ''Y �h 7 L�� ' �' i� G G'� CONTACT PERSON/PHONE: LOCATION OF SERVICE: S�,»'l� 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 1Re ced Pressure Principle I Reduced Pressure Principle-Detector - ouble Check Valve C Double Check-Detector [ IPressureVacuumBreaker I Spi11-Resistant Pressure Vacuum Breaker ll Manufacturer �. � Model Number (�fl��i �� Size_� Located At Y'1 �� Y(�� f➢Y�'t �� Serial Number��r��'� � Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �i/� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve � Air Inlet Check Valve 1 st Check 2nd Check Held a��psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight�� Closed Tight ,X psid psid psid Leaked f Leaked I Did not open I Did not open ' 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 Test gauge used: Make/ModeV'� y`l✓��7�� SN: � �_yf.��_ Date Tested for Accuracy: //�s ��o; Remarks: The above is certified to be true at the time of testing. FirmName,�C r�'� �U�'Y�? Firm Address�/3l.Z�i� �r�+'6��1i0NtC�X��/ I Certified Tester(pr:nt��►"��L�Ll�� Certified Tester(signatur Firm Phone#��d�� Cert.Tester N �r��Date �S * TEST RECORDS MUST BE KEPT FOR AT LEAST T E 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 far 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 LG✓ E�t YI��C.t U/J CONTACT PERSON/PHONE: V. � ' LOCATION OF SERVICE: �Sf,��n 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 ::1Reduced Pressure Principle i7Reduced Pressure Principle-Detector �ubleCheckValve �: IDouble Check-Detector ��I Pressure Vacuum Breaker �Spill-Resistant Pressure Vacuum Breaker � ` // Manufacturer�,JGL J Model Number (f��/ Size,�� Located At �S�'�Y �QD�'� ��.� Serial Number (D/Cl��F Is the assembly installed in accordance with manufacturer recommendations and/or local codes? G� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve lst Check 2nd Check Held a��psid I�eld at/��psid Opened at Opened at Held at �Initial Test Closed Tight.l� Closed Tight 1� psid psid psid Leaked I Leaked�� I Did not open �� I Did not open � 1 Leakedl I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight_I Closed Tight i I psid psid psid Test gauge used: Make/Model�i�G( d�/C��" t��f..� -.� SN: � �U Lf d�S d Date Tested for Accuracy: ��j S, /,/$� Remarks: , The above is certified to be true at the time of testing. FirmName�� rn� Firm Address�(��7 Gru,�aGll��i1GT�� Certified Tester(prart r Certified Tester(signature Firm Phone#�/7�� /�Q Cert.Tester No.��Q'0/��(Q � Date �� f * 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 far 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� � 1 ' e �� ` e�� ?Sl�/ CONTACT PERSON/PHONE: /vI,� C� QdG� LOCATION OF SERVICE: �b�yl 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 CReduced Pressure Principle-Detector � ouble Check Valve I�Double Check-Detector IPressureVacuumBreaker GSpill-Resistant Pressure Vacuum Breaker Manufacturer__�'"`� Model Number // �� Size� Located At ,O�Ins�r Y�0/yl. o��/J Serial Number �e �� 3� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �P.J Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held�� psid Held at��psid Opened at Opened at Held at Initial Test Closed Tight�� Closed Tight � psid psid psid Leaked' I Leaked�' Did not open C Did not open ❑ Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight C1 ClosedTight J psid psid psid Test gauge used:Make/Model��l/�S1`t� �,S'- � SN: /�Sj()�/G��f.S a Date Tested for Accuracy: �/ � S � � S �T� Remarks: The above is certified to be true at the time of testing. Firm Name��td'd l�-��/�'� Firm Address �� t7 GY C✓�' �� / �/� � Certified Tester(pr�nt�L'Y'�'��(��U� Certified Tester(signature "G�� Firm Phone#��.��f�QQ Cert.Tester No�,l�� Date l�� * 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 I.D. #0570040 (Customer) , � _ / � �� MAILING ADDRESS: 7` � ✓� I 7 � i�/►� �!%� S a f CONTACT PERSON/PHONE: �� ' LOCATION OF SERVICE: Se,,,�. 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 ��R�e uced Pressure Principle ❑Reduced Pressure Principle-Detector �7OubleCheckValve ClDouble Check-Detectar ❑PressureVacuumBreaker I�1Spill-ResistantPressure Vacuum Breaker � �L� Manufacturer�i✓l �7�'� Model Number 7�� Size 21/ Located At �'�S'G 'Y rl�0'/1? �� 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 TightLY Closed iT"ght I�- psid psid psid Leakedl�! Leaked� 1 Did not open �_J Did not open i.-1 Leakedl : Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight C] Closed Tight I�I psid psid psid Test gauge used:Make/Model� �l L�' ��y✓ J SN: ��S� Date Tested for Accuracy: ��,/�S�� S'' ' Remarks: The above is certified to be true at the time of testing. FirmNam�'/" t►�� 1l�1 Firm Address�(�,��7,�t7 �r(1JW��AC `l� ��/ CertifiedTester(prir.t��-�f� �G�jpO� CertifiedTester(signature) � Firm Phone# 7' ��'��6� Cert.Tester No Q 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 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: ��'�1l I7) 7 � e f' ` � � ��C� �J` CONTACT PERSON/PHONE: �� (J �U U LOCATION OF SERVICE: ��rrl 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 ��Re uced Pressure Principle ❑Reduced Pressure Principle-Detector — ouble Check Valve C]Double Check-Detectar ❑Pressure VacuumBreaker �1 Spill-Resistant Pressure Vacuum Breaker � �/ Manufacturer � �S Model Number Q Q 7/YJl Size� Located At Y'/, � r x��i lr�� 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,� psid psid psid Leaked�1 Leaked��.1 Did not open I 1 Did not open C- Leaked�l Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight l I ClosedTight l psid psid psid Test gauge used:Make/Model�/��I(��✓ C'Sr �� '-� SN: Q �f U�'l� �� Date Tested for Accuracy: _��f�� Remarks: The above is certified to be true at the time of testing. FirmName�,�}�"��d�,dy Firm Address�fl,�l,��/��'ht�ylG[J��/L� l�� Certified Tester(pr��nt) ��'L— Certified Tester(signature) �!�� Firm Phone#��2��f �70'U Cert.Tester No. �� 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 D ME TI FIRELINE � O S C 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) ) / y� MAILING ADDRESS: S�: /1��',',� J � ) � � �G/f('�, G/`C� ��G/� CONTACT PERSON/PHONE:��'7,Z �� DOD LOCATION OF SERVICE: 5�,� vr1,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 IJR duced Pressure Principle ❑Reduced Pressure Principle-Detector I�ouble Check Valve �1 Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker r� /� Manufacturer ��7`�S Model Number �� /� � Size�_ Located At �I�C b� )'D 4 jv� �� Serial Number �/��l 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 Inirial Test Closed Tight� Closed Tight !� psid psid psid Leaked[.] Leaked�l Did not open C�� Did not open f 1 Leakedl 1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight� ClosedTight��J psid psid psid Test gauge used: Make/Model 6 � � r S' SN:��/� �� Date Tested for Accuracy: � J Remarks: The above is certified to be true at the time of testing. Firm Name/'/ Qtt�v L.11'1�1/YJ Firm Address��13�2�i�(SI'/,_dCf//� �. /,}��7� Certified Tester(print) � T ��C� Certified Tester(signature) � 2 Firm Phone#�� (,�� Cert.Tester No j��U��/ Date ��•2 ��.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 LD. # 0570040 (Customer) /' � MAILING ADDRESS: ,S� �YJ11 `�/� L�,��./1`9��'f C 0 ��C1/� CONTACT PERSON/PHONE:�1� �,��, L�{� �U o� LOCATION OF SERVICE: S�m � 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 �Reduced Pressure Principle-Detector �uble Check Valve ❑Double Check-Detector �PressureVacuumBreaker ClSpill-Resistant Pressure Vacuum Breaker � ��"� Model Number [.�(,��/'[ � Size �� Manufacturer /; Located At �'�/t�/, �Y' �'C1�i � /�``(�G Serial Number � / � —.-,-�- - � � ��s 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 lnlet Check Valve 1 st Check 2nd Check Held a��psid Held at�psid Opened at Opened at Held at Initial Test Closed Tigt�f Closed Tight.� psid psid psid Leakedf 1 Leakedl—I Did not open I I Did not open f � Leaked� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ ClosedTight� 1 psid psid psid Test gauge used: Make/Model �"l�"� � �y�`� SN: ��G�y�� Date Tested for Accuracy: �//..S /rS Remarks: The above is certified to be true at the time of testing. FirmName�G �ro �l�/�'l�, Firm Address �U�l.��i��t�/��Uy/�e ��'��U�� Certified Tester(print).�e��,�L�G v� Certified Tester(signature)� . ' � Firm Phone#��C��1 Cert.Tester No. /`"liY}�' �p�(�p� Date ��-2 �� * 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 1.D. # 0570040 (Customer) 9 � -/ � MAILING ADDRESS: f r�� I1 /� �� ( !'�G ��` � � CONTACT PERSON/PHONE: � C� ��C) LOCATION OF SERVICE: S'�m 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 uReduced Pressure Principle �,Reduced Pressure Principle-Detector �ubleCheckValve �Double Check-Detector -7PressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker ,�,�/� �/ Manufacturer �C �_5 Model Number ��'7 � Size� Located At Yr"�� Q � ��4 �� Serial Number Is the assembly installed in accordance with manufacturer recommendations andlor local codes? �'� Reduced Pressure Princi le Assemb] Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at��psid Held at�l psid Opened at Opened at Held at Initial Test Closed Tight�✓ Closed Tight � psid psid psid Leakedl I LeakedC Did not open C1 Did not open f�I Leaked 1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�7 ClosedTightC! psid psid psid Test gauge used: Make/Model �� ?`��-5 ��J� SN:�J�Q�(�� Date Tested for Accuracy: � Remarks: The above is certified to be true at the time of testing. Firm Name p "( .r1�l� CJ mi � Firm Address��/,1�2�! ��-��'�1�� Certified Tester(pr�nt��°v'►^c, ,�C�� Certified Tester(signature)�-- � � Firm Phone#97��/�? �Q Cert.Tester Nq�I��lj/��''�� Date .22 � * 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 far recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) �+ MAILING ADDRESS: It" o� J� Lt'� G/f' �'' G � � CONTACT PERSON/PHONE: h r- � Q 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 �uble Check Valve �Double Check-Detector i�7pressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker %� %� Manufacturer / /',�, ��✓ Model Number � � � Size� Located At L C��s ��c �''it��f a''��y�t Serial Number ��_7� � 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�c� psid Held atf��psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid Leakedl�J Leaked[ ] Did not open I I Did not open .1 LeakedCl Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�_J ClosedTight f 7 psid psid psid Test gauge used: Make/Model��`(' ��C,Sr��S",� SN:��U ��D �S� Date Tested for Accuracy: �J�/�� Remarks: The above is certified to be true at the rime of testing. Firm Name�C l��t� �C/�+'��''� Firm Address��lZCo��1-�� l�c� �j�� Certified Tester(pr�nt�C, 7�y'G��CJ�� Certified Tester(signature) � Firm Phone# -�1�� / ��Q� Cert.TesterNo��lT40 �� 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 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: ��, �t '/7 � c� � ," J� G�/ CONTACT PERSON/PHONE: � y. �' f� '�O LOCATION OF SERVICE: �S�,rr✓! � 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 JReduced Pressure Principle JR�duced Pressure Principle-Detector C Double Check V alve �Double Check-Detectar ❑PressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker Manufacturer ��i(�C� Model Number 4/�� Size � Located At �G S f �� u�� Serial Number ��!� 6� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi ]e 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 Tigh� Closed Tight � psid psid psid Leaked':] Leaked��I Did not open [.�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 I I Closed Tight❑ psid psid psid Test gauge used: Make/Model/��c � �. ��y� �� SN:��1�� r�fJ Date Tested for Accuracy: �/ l.S � � Remarks: The above is certified to be true at the time of testing. � FirmName/��'L,� �' n2/�'1 Firm Address G�./�/,��7(�r��y��U�hcT�� U �� Certified Tester(print��r ,��-�f1 Certified Tester(signature) �'//�NL� Firm Phone#�� j�Cert.Tester No �� 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 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: �'- � � r G � G� �1 CONTACT PERSON/PHONE: + D LT�U 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 i�lRe ced Pressure Principle ❑Reduced Pressure Principle-Detector l��ble Check Valve ouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker / I�� Manufacturer !�/�n �`� Model Number ��Z�Z Size�� Located At ��1� I�C..Lt /� Serial Number/� 3��_ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �j Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held�� / psid Held a��psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight� psid psid psid Leaked❑ Leaked�l Didnotopen ❑ Didnotopen fJ Leaked�. I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight J Closed Tight I� 1 psid psid psid Test gauge used: Make/Model� ��5 �� SN: C1�� Lf��C� Date Tested for Accuracy: /��,Sf /.S~ Remarks: The above is certified to be true at the time of testing. FirmNam��'�r� ��/''�[ Firm Addressp-��'��v�hC�a`��1/ Certified Tester(pr:nt��'r�.��"ICCJI�� Certified Tester(signature � � Firm Phone# ��.�Cr�.�� D �� Cert.Tester N��7 Date /z2 * 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 LD. # 0570040 (Customer) � MAILING ADDRESS: G� r, �n 7 �✓ G lE'% � G ?✓�Lt� CONTACT PERSON/PHONE: !�/ • ' ' G LOCATION OF SERVICE: b�. ��y✓1�� 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 GReduced Pressure Principle-Detector ❑Double Check Valve �� ouble Check-Detector ❑PressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker ^ // Manufacturer ��'�C(`J Model Number /✓�G�� Size�_ Located At��,��n t�t / �' Serial Number�C__�_7 � � 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�X Closed Tight � psid psid psid Leakedf�I Leaked❑ Did not open �� 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 1 ClosedTight❑ psid psid psid Test gauge used: Make/Model � r •� SN:I��l��'�C� Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. FirmNam��C�',�'� LQ/�11�1 Firm Address�� r - � ��7 7 Certified Tester(pr�nt) ��s y' � � Certified Tester(signature) �G Firm Phone#y/�� ?�� Cert.Tester No��U��p�% 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 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) y�� > MAILING ADDRESS: �� G'" rGi Y�I� � � �� r� C � ��1 CONTACT PERSON/PHONE: n r � Q Q 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 �Reduced Pressure Principle-Detector ��I Double Check Valve �'IS'ouble Check-Detector �lPressureVacuumBreaker '-1Spi11-Resistant Pressure Vacuum Breaker Zl Manufacturer � l�rrs Model Number 6�� Size� Located At �/,��, � 'd L�l � 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 a�r�psid Held a�� 0 psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid Leaked�1 LeakedCl Did not open [ I Did not open ❑ Leaked--1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ ClosedTight❑ psid psid psid Test gauge used: Make/Model ,� �' �� SN��Q��d�S� Date Tested for Accuracy: J /S �-� Remarks: The above is certified to be true at the time of testing. Firm NamP,�� '7`�'C� C..c�yn/Y! Firm Address/��'��1/G'2'� ��s ',�� Certified Tester(print ��'r � Certified Tester(signature) • ' � Firm Phone#�� 7��2�� Cert.Tester N��$ � � 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