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2015_1025 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) Ma1LiN� aDDxEss: ��b3 1r.�rarl�ilc,- Cir CoP�el( � CONTACT PERSON/PHONE:L-o u c S ��.iaS Z I� '�{5 l, —Q,b�c� LOCATION OF SERVICE: 1_Z�� I�o--F"�. �a �ac� 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 f Reduced Pressure Principle-Detector C�ouble Check Valve I 'Double Check-Detectar '-1PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker k�4-t-�s ` Manufacturer Model Number Ob7 P►'1 1 (�T Size z� Located At �• D� '�Y'a � �' C�L Serial Number `��y z 3 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 �• b psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight XI psid psid psid Leakedl I LeakedC'; Did not open I l Did not open ' I Leakedf Repairs/ Materials Used Test After Held at psid Held at psid Opened at Opened at Held at Repair Closed Tight;.7 Closed Tight I psid psid psid Test gauge used: Make/Model l.-9Kl�i`a�o�0"Z�`" �� SN: ZSgbb O Date Tested for Accuracy: q�ZS I IS� Remarks: The above is certified to be true at the time of testing. Firm Name�[�pe�� fl Firm A ddress (� iV' � �I� � Certified Tester(pr�nt) � �� ' ° Certified Tester(signature) Firm Phone# �� 1 —� 1��6� Cert.Tester No. ��S�f3 Date � o� � * 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: � 3 O �J (,t��a+'��''� L.i� CONTACT PERSON/PHONE: ��i S '�t�C�aS M4LiAS Zf�— �{�`-$(�c�a LOCATION OF SERVICE: l 7A a e5 �'�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 ]Reduced Pressure Principle IReduced Pressure Principle-Detector fj�iDoubleCheckValve �Double Check-Detector [PressureVacuumBreaker � Spill-Resistant Pressure Vacuum Breaker .z�� Manufacturer �a�'S Model Number 00� (� � (�� Size ��— Located At�� fraG2 I�U� � Serial Number `�J 7D� � 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 Tigh� Closed Tight� psid psid psid Leakedf 1 Leakedl ' Did not open I I Did not open I� I LeakedC Repairs/ ��'� 1 C�5� �,L1L Materials Used Held at i psid Held at Z,�b psid Test After Opened at Opened at Held at Repair Closed Tight� Closed Tight'�('I psid psid psid Test gauge used: Make/Model �m�rc�L �d` Z��7� SN: Z�bt�� Date Tested for Accuracy: R�Z� lS� Remarks: The above is certified to be true at the time of testing. FirmName�E��11 .1� Firm Address �J� V��'bt e ��r' C9 l l � Cerrified Tester(print) � � Certified Tester(signature) Firm Phone# 'Z��`� I�'-Db� Cert.Tester No��p�s� 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 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: ��O3 �'��e�' 1..:r. D�M e11 �X CONTACT PERSON/PHONE: �p��'s G�C�.,i a5 ��'�-4`t lo ` �oy v LOCATION OF SERVICE: ( ZO N�t�'e.In.eS �l ac� 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 �IReduced Pressure Principle ❑Reduced Pressure Principle-Detector �DoubleCheckValve �Double Check-Detector IPressureVacuumBreaker lSpill-Resistant Pressure Vacuum Breaker Manufacturer �.�3b.�� ,5 Model Number db� � i aT Size 2�� Located At SoC�� W. COrY��' 6��v� ��C Serial Number 2�� 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 �'� sid Held at �� psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight� psid psid psid Leaked��'�1 Leakedl�I Did not open I�J Did not open � I Leaked I I Repairs/ Materi al s Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight ] ClosedTight' I psid psid psid Testgaugeused: Make/Model �Drn�1'`C�t_.c� ��`�O�L SN: ��$DdC7 Date Tested for Accuracy: �r ZS~'�� Remarks: The above is certified to be true at the time of testing. Firm Name L�D�� -1-�� Firm Address �3� ��h �,�(' 1�1�ir' � e� ✓ Certified Tester(print) r � Certified Tester(signature) Firm Phone# �� `� � -l�� D�'N Cert.Tester No. k�I��o'�sgj 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_ C�A 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�O3 � �'U'� IP� �1 "'� CONTACT PERSON/PHONE: �-Dul �c,+aS 2I — � " O LOCATION OF SERVICE: Z-o � a %�Q �� 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 ��1Reduced Pressure Principle-Detector �oubleCheckValve CDouble Check-Detector �PressureVacuumBreaker I ��Spill-ResistantPressure Vacuum Breaker � / Manufacturer Q�S Model Number �� Size � Located At �9�� • 4�� W•��L Serial Number `�J��l� Is the assembly installed in accardance 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 Ileld at �I� psid Held at �,�t psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight�] psid psid psid Leaked'��1 Leakedf I Did not open �.l Did not open � 1 . Leakedl�l Repairs/ ��4c�—�� Q.. S 6'� �q q�G Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�� I ClosedTight f I psid psid psid Test gauge used: Make/Model K1��-�b ��'�"O0�K SN: 2� �d d� Date Tested for Accuracy: �I ZS �S� Remarks: The above is certified to be true at the time of testing. FirmName CaQpel� -�-s� Firm Address ��b� �t`Gt,l'lR��►'� ��r CertifiedTester rint � (p � )�Ql�� 1 Certified Tester(signature) N` � � Firm Phone# �R ��0 �� Cert.Tester No. 1�� n� �Cj Date �D �7 �� * 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 C 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) MaiLiN�a��REss: 13b� a� ��r ' 1 �X CONTACT PERSON/PHONE: 'S LtS L - O LOCATION OF SERVICE: l Z.� —' 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 �ouble Check Valve ��1 Double Check-Detector ']PressureVacuumBreaker 7Spi11-Resistant Pressure Vacuum Breaker ' - 1 ; � Manufacturer WQ�S Model Number �� ( (�1' Size � Located At �Je�i v�J� L'OPlGe55 i01'1 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 Tight�+ Closed Tight '� psid psid psid Leakedl I Leaked❑ Did not open ❑ Did not open �1 Leakedl Repairs/ Materials Used Held at psid I-Ield at psid Test After Opened at Opened at Held at Repair Closed Tight.l Closed Tight-.J psid psid psid Test gauge used: Make/Model l��n�rGtCp ��lL sN: 25$ooa Date Tested for Accuracy: � �Zd 1 l S Remarks: The above is certified to be true at the time of testing. Firm Name��G� ,LS� Firm Address � � W I�Q �'(^ e)� � � ` � Certified Tester(pr�nt) � Certified Tester(signature) � /I / Q �,,,�hr � � Firm Phone# �� - 7�(0 ''�Cert.Tester No.IJ��I.x.�o�s�j Date �O ' 1 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