Loading...
2015_1215 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: ,$�.�w Lo►/ct, /2 � G f _r �So/9 CONTACT PERSON/PHONE: a1-�Z.y�2. ��00 LOCATION OF SERVICE: /c,//f� E. Sa,.�,e/N Le�� The backflow prevention assembly detailed below has been tested and maintained as required by commission regularions and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY i Reduced Pressure Principle ' Reduced Pressure Principle-Detector Double Check Valve +kbouble Check-Detector C���PressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker Manufacturer�f e�f�'s ' Model Number '7S'� Size �r,O'' Located At �Q's�# I�o�,�,t�f'. Serial Number /�q - 2903 Is the assembly installed in accordance with manufacturer recommendations and/ar local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�_�psid Held at 3.3 psid Opened at Opened at Held at Inirial Test Closed Tight✓ Closed Tight I� psid psid psid Leakedl I Leaked' I Did not open Did not open ' Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight� 1 ClosedTight I psid psid psid Test gauge used: Make/Model (.✓T/l�e;..s �!"6$ SN: ��0���93 Date Tested for Accuracy: �O�z/,,2o/S Remarks: The above is certified to be true at the time of testing. Firm Name D�✓ers�-�;� f:�� F�at.Firm A ddress_�Qy/ �1,"o/.✓cw FG✓ 'T?C 7100/� Certified Tester(prf�r) $�„� �;{���«Certified Tester(signature) - — Firm Phone# g/'7. Ff3�1. Cv40/ Cert.Tester No. 00/�l O 93 Date/Z /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 I.D. #0570040 (Customer) MAILING ADDRESS: �,� La,,� �Q�e �-��,� .����c� CONTACT PERSON/PHONE: 9'�Z. �/vZ. LGOO LOCATION OF SERVICE: /S//p � �——� La,Ee.. . The backflow prevention assembly detailed below has been tested and maintained as required by coinmission regulations and is certified to be operating within acceptable parametcrs. TYPE OF ASSEMBLY � ��Reduced Pressure Principle �1Reduced Pressure Principle-Detector � I iDoubleCheckValve {/bouble Check-Detector � IPressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker Manufacturer_�a.-{�s ModelNumber 7S7 Size �'r, � �� Located At I,�p.af ��«u � Serial Number��— /3ZZ Is the assembly installed in accardance with manufacturer recommendations and/or local codes? ers Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at3.�f psid Held at 3.9 psi Opened at Opened at Held at Initial Test Closed Tightl�.Y Closed Tight �� psid psid psid Leaked. ' Leakedl 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 Closed Tight�' Closed Tight I � psid psid psid Test gauge used: Make/Model_�[�„� ?'C„�� SN:_ �,7�0-�/!09 3 Date Tested for Accuracy: ♦p�Z,/�ZD/.S Remarks: Va,.,.ff ��// c� wa#er ,/ s�.'dl �n�.rb� (ao��_�o re.,.� V J � � ✓a��1/�c `le�r� 'f0 fL r h The above is certified to be true at the time of testing. FirmName :r�esif'•� Fr�- pref Firm Address�q�// ,r./,a/,.�� FI,J T�C ��//7 Certified Tester(pr�int)5�,._ L,fff���.�. Certified Tester(signature) �, , Firm Phone# a I'7. a 3 N. !o�(Dl Cert.Tester No. O o/�10 9 Z. Date /2�O��z,ai,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 l.D. #0570040 (Customer) MAILING ADDRESS: S'.�,.oly �e�/cQ, �Q 3 G �Q.n-Fet- �5 O/9 CONTACT PERSON/PHONE: 9�-�2. yV2.G�oO LOCATION OF SERVICE: 15�/D E Sa..,dy.�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 IReduced Pressure Principle-Detector +�bouble Check Valve �� Double Check-Detector I �PressurcVacuumBreaker f�'��Spill-ResistantPressureVacuumBreaker .i Manufacturer L�/o� Model Number 00� M 1 [,�Size Z.O Located At Nnrr'1'�. rv�e�ef' ��C Serial Number y$��� Is the assembly installed in accordance with manufacturer recommendarions 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�1 Closed Tight �� � psid psid psid Leaked{�! Leakedl4l� Did not open ��� � Did not open ��� Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight� ' ClosedTightl psid psid psid Test gauge used: Make/Model 6✓i��C�r�s TG-�5 SN: O�O�/l��I_�_ Date Tested for Accuracy: _/0�2/�zv/,.S Remarks:�ss+e�.�,blii rrte.�s re..bui��. The above is certified to be true at the time of testing. FirmName D��G�si�:� �ir� �ef.Firm Address ,5+4s�/ M�elwa� �{n! 'T?C 7L�/�7 Certified Tester(pr�nt)5�.,� ���f��,�n�Certified Tester(signature) � � Firm Phone# �l'7. S3�1. ��I O I Cert.Tester No. 00/�J 09 2 Date /Zo/S�ZO/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 I.D. # 0570040 (Customer) MAILING ADDRESS: �91�� ��/c� /Z � G Gc,�-}p� '7S0/9 CONTACT PERSON/PHONE: 972. N�oZ. fe 4 o O LOCATTON OF SERVICE: /y/p a,,,�o/w ,,[,�,,,(� 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 � IReduced Pressure Principle-Detector ���ouble Check Valve ��� Double Check-Detectar f iPressureVacuumBreaker ` ISpill-Resistant Pressure Vacuum Breaker Manufacturer W a}fs Model Number 00� �'13 Size . 7S '� Located At��f �/a,,,,�d�- Serial Number Zpp�e/ Is the assembly installed in accordance with manufacturer recommendations and/or local codes`? �e.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 Z.Opsid Held at 2.Z.psid Opened at Opened at Held at lnitial Test Closed Tightf�/ Closed Tight f✓ psid psid psid Leaked'�� I Leaked I Did not open I 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 Closed Tight I Closed Tight I psid psid psid Test gauge used: Make/Model /�/;/�ci„s TG S SN: 2-�0'�/��t 3 Date Tested for Accuracy: /O Z�� Z o/S Remarks: The above is certified to be true at the time of testing. Firm Name rC7,'v��s:-�.'� E i-� P.�f Firm Address �Se�y� /YJ,'o/r,/�e,,� �j,�J -rX 7G//� Certified Tester(prYnt),$�,o�� �,�� e�Certified Tester(signature)���__ Firm Phone# �g/7. fi3� (o51OA Cert.Tester No. �p/�109?_ 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 ariginal must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: C1TY OF COPPELL PWS I.D. # 0570040 (C ustomer) � MAILING ADDRESS: So�n�y L,a►.�ct Q 3 G t��''r �5 0/q CONTACT PERSON/PHONE: 9�2_ '1 foZ. (o!0 0 0 LOCATION OF SERVICE: /�,//p � �� La,/��_ The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certifted to be operating within acceptable parameters. TYPE OF ASSEMBLY R duced Pressure Principle ��Reduced Pressure Principle-Detector ���ouble Check Valve � 1Double Check-Detector 1PressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker Manufacturer f,✓o,,{¢,s Model Number O�7 M/ ��Size . 75 �� Located At_ (,�f e,�sf �Ja..�S� Serial Number ZOp��,5 Is the assembly installed in accordance with manufacturer recommendarions and/or local codes? ts 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 2.� psid Held at 2•�psid Opened at Opened at Held at Initial Test Closed Tightlt� Closed Tight I✓ psid psid psid Leaked f I Leaked.�I Did not open f 1 Did not open I '� Leaked l ���� 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 G✓i'��e;Ns T�a S SN: Q�O�/ro9 3 Date TestedforAccuracy: /O�Z/�zo%5 Remarks: �/�I�f.,,,// o-f` ,�o��er / �uw,b«a l,e.ral �o• reo►al The above is certified to be true at the time of testing. FirmName �i�e�s:�'ee� ��e.. �r+af Firm Address Sq�f 0 i"l�o%✓aw Fl.J �JC 7(0//� Certified Tester(pr�nt)Seaw., L.��Q.�a..Certified Tester(signature) � -- Firm Phone# a/7'. �34. ��Io/ Cert.Tester No.�D/�09 Z 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: �o,�� 1✓a�� /2 � C A -1-�� —750/ 9 CONTACTPERSON/PHONE: 9"7Z '1�oZ. (e�oCap LOCATION OF SERVICE: /y0�f � Sa.�T La�cs. 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 �Double Check Valve � Double Check-Detector ' IPressureVacuumBreaker � ISpill-ResistantPressure Vacuum Breaker Manufacturer (,✓Q#.S Model Number op� M/ 6t'7' Size 2.0'' Located At So�.cfl. �l�'fa.r �ox Serial Number yG,�/� 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 l• (o psid Held at /. �f psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight v1� psid psid psid Leaked'' Leakedl ' Did not open Did not open ' Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight 1 ClosedTightl��� psid psid psid Test gauge used: Make/Model (,✓://c,:�s TCZ S SN: p�p�/�9 3 Date Tested for Accuracy: /a�2/ ,✓ 2.o/S Remarks: The above is certified to be true at the time of testing. FirmName p;�ers;�:•s.a� /�'r� ��a,f�.Firm Address S9•// �l.al.r� �-�W TX '76//'7 Certified Tester(pr=nt),See,� �;�l�fo,�Certified Tester(signature) � � Firm Phone# a��_ s3 y. �40/ Cert.Tester No. 00/5/09 2 Date/Z��S�ZO/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