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2015_1111 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: �00 �To�r �w-� CONTACT PERSON/PHONE: MIS�� 9�Z• 3��' 11� LOCATION OF SERVICE: SAMm' 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 -1Reduced Pressure Principle-Detector �� I Double Check Valve ��1�'ble Check-Detector ��'�PressureVacuumBreaker i�lSpill-Resistant Pressure Vacuum Breaker Manufacturer �S Model Number 79`/ Size 8�1 Located At Nl✓ YMwt Serial Number /00//TO�o/ 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 Z'�/ psid Opened at Opened at Held at Initial Test Closed TighuX Closed Tight I� psid psid psid Leaked��I Leakedl 1 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 ClosedTight 1 ClosedTight f l psid psid psid Test gauge used: Make/Model �6�A�o d/0 s0o r'K SN: 3J/23� Date Tested for Accuracy: �� tf'�`� Remarks: The above is certified to be true at the time of testing. Firm Name �o� f�'Iri �Aos Firm Address ��• �0� �� T• �f�`f Certified Tester(pr:nt) Certified Tester(signature) Firm Phone# �-NO• j,�d- Z1Q1 Cert.TesterNo. BPOtl1��Nb Date ll'�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 recordkeeping purposes: � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAM� OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: �� loat �jr,.�� CONTACT PERSON/PHONE: �it� +��'N�r+ 91Z'3!►/ • ��ro LOCATION OF SERVICE: Sq�'U►' 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 i IReduced Pressure Principle-Detector i�uble Check Valve ! IDouble Check-Detector I�IPressureVacuumBreaker �Spill-ResistantPressure Vacuum Breaker Manufacturer ��"'�t5 Model Number ��N�� Size 3� �� Located At � �� 'T Serial Number �� 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 ]st Check 2nd Check Held at �' $ psid Held at �'% psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight ►-I� psid psid psid Leaked� I Leaked �I 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 Tight I Closed Tight I psid psid psid Test gauge used: Make/Model ��'� �10 t+o T7e SN: ;3/t37 Date Tested for Accuracy: �/•tf-/� Remarks: The above is certified to be true at the time of testing. Firm Name l%��^� ri`d /.�J Firm Address ��• a+r �1� ('✓pK �' TlG ?s'/� Certified Tester r�rt � N/ � (p � ) /1 Certified Tester(signature) Firm Phone# �•roG• Sr0•ZZJ� Cert.Tester No. ��d ��yd Date �!'!1•L� * 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 PREVENTlON ASSEMBLY TEST AND MAlNTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: LOO �1�� lu'� CONTACT PERSON/PHONE: M�S1Y N�K qn-'341• d?S'a LOCATION OF SERVICE: 5qµt The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operaring within acceptable parameters. TYPE OF ASSEMBLY � Reduced Pressure Principle i-Reduced Pressure Principle-Detector '�ub1e Check Valve i Double Check-Detector �-PressureVacuumBreaker � Spill-Resistant Pressure Vacuum Breaker Manufacturer NR�TS Model Number Da�� Size Z�� Located At �W WA�1�(� R� �� Serial Number ��Sqr 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 I st Check 2nd Check Held at �• �psid Held at /•�i psid Opened at Opened at Held at Initial Test Closed Tight V Closed Tight � psid psid psid Leakedl I Leakedl �� Did not open C I 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' Closed Tight I psid psid psid Test gauge used:Make/Model �^/Q��+ '�' u� f� SN: .�Jit3� Date Tested for Accuracy: ��'tT'�'✓ Remarks: The above is certified to be true at the time of testing. FirmName �f/��✓ � ' /•��s Firm Address �d- ?7t I�A'� /L,J' Certified Tester(print) /d� Certified Tester(signature) Firm Phone# /-1�°0 •Tra' tZ�� Cert Tester No. $�00//9N6 Date ��' ��'�r * 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) G -/ MAILING ADDRESS: ((OD fM�PYI� ��7 CONTACT PERSON/PHONE: M�st� H��{ h1t• 3G1 • 6?,3'D LOCATION OF SERVICE: � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operaring within acceptable parameters. TYPE OF ASSEMBLY �� Reduced Pressure Principle ��Reduced Pressure Principle-Detector �ubleCheckValve lDouble Check-Detector �PressurcVacuumBreaker ��JSpill-Resistant Pressure Vacuum Breaker �r/ Manufacturer WM't S Model Number B01µ� Size Located At J� (N�� At �r�'1L Serial Number ��1 Z Is the assembly installed in accordance with manufacturer recommendations and/ar local codes? Fi'� 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� Closed Tight f"� psid psid psid Leaked� I Leakedf I Didnotopen i I Didnotopen I Leaked'�� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight��. I ClosedTight�.7 psid psid psid Test gauge used: Make/Model �riv6�� 'Y� �o � SN: 3.T/Zf 7 Date Tested for Accuracy: ��'Zl•�.� Remarks: The above is certified to be true at the time of testing. Firm Name C>�/.✓ �it� ��J Firm Address P�• � 79� !�✓4�.a "`id 7k• 7`r�� Certified Tester(pr�nt) �t /��AA� Certified Tester(signature) Firm Phone# /•dro• SSO•Zyd 1 Cert.Tester No. 8/�DO��y6 Date ��'��'�� * 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 far each assembly tested. A signed and dated ariginal 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: �ldd FilCb'�N.t �� CONTACT PERSON/PHONE: �3T N��H °l?L• 1�� • It11'+� LOCATION OF SERVICE: k� �ot.f 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 paraineters. TYPE OF ASSEMBLY �� Reduced Pressure Principle ❑Reduced Pressure Principle-Detector � i�ble Check Valve C�Double Check-Detector -'PressureVacuumBreaker f ISpill-Resistant Pressure Vacuum Breaker Manufacturer ��t S Model Number D�7�� Size 7�y I/ Located At �W Y��t Serial Number y�3GG Is the assembly installed in accordance with manufacturer recommendations andlar 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 j'Z psid Held at �� psid Opened at Opened at Held at Initial Test Closed Tightr'l� Closed Tight �F=1� psid psid psid Leaked.�1 Leaked.�I Did not open '� � Did not open I I Leakedi �� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight I I ClosedTight[�� psid psid psid Test gauge used: Make/Model ��/6Hc� �/d tao T� SN: 3 3i Z3 7 Date Tested for Accuracy: //' Z.j'� Remarks: The above is certified to be true at the time of testing. FirmName ��0� ��it6 /�i�/f Firm Address �o- 8�� T4T �'✓�t �r' Tl/6,f' ,�/ � Certified Tester(pr;nt) /p11�i��I✓/d'� Certified Tester(signature) Firm Phone# /P,0�0• ,��•azd 7 Cert.Tester No. ��°�tL� Date //- //•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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) L �/ MAILING ADDRESS: I(�d /Ati1i�IN� �w1 CONTACT PERSON/PHONE: /I�IS�'/ �K� �lZ• 36�' b�f� LOCATION OF SERVICE: Swr�� 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 uced Pressure Principle I:Reduced Pressure Principle-Detectar ouble Check Valve '�� 1Double Check-Detector ��PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer YVKt1S Model Number �� Size !/ � Located At �� Av�t Serial Number //U L/0 0 3,�a 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 2'3 psid Opened at Opened at Held at Initial Test Closed Tight��Y Closed Tight 4� psid psid psid Leakedl 1 Leaked'��1 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 I��l ClosedTight I psid psid psid Test gauge used: Make/Model �i��r.o ya toi 7'K SN: ��/Z3 7 Date Tested for Accuracy: ��tf"�� Remarks: The above is certified to be true at the time of testing. FirmName_ �� /�t Firm Address ��-80� Z41 qxswlc�v � 71��,/ Certified Tester(pr�nt) � ��ilG Certified Tester(signature) Firm Phone# l•ddv- �,s'o• tzg''i Cert.TesterNo. al'vD ��?'�16 Date ��'��'�r * 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