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2016_0115 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 far recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. #0570040 (Customer) MAILING ADDRESS: S4w�Q� CONTACT PERSON/PHONE: P � - - 04 LOCATION OF SERVICE: ��\ock se��" S+or�qc. 3zo S. H....-, �Z� nJo�+b. The backflow prevention assembly detailed below has been tested antt�main'ta ned�as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detectar 64DoubleCheckValve i 1Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer F�bc.o Model Number $o S Yl3 Size �/y�� Located At iN „6�I+ �., $'�,ss•�+61�� u.�Y,.uried�d s�rial Number �Krud..J�l� dw.1,� �orro5�:� 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 lnlet Check Valve 1 st Check 2nd Check Held at�H psid Held at I,(� psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid S Leaked ] Leaked' 1 Did not open ❑ Did not open i�_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.I psid psid psid Test gauge used: Make/Model fJ�o�lo �Ko zooT�cSu SN:o�oSz2't`1 Date Tested for Accuracy: i�--Z3- 1 S Remarks: The above is certified to be true at the time of testing. Firm Name��,��-,��.� Sdr.:�El�. o�T�x..�.s Firm Address i�ti�t S, L�lar Q.d�� DN�'lCcaKv��'�-J�l� �s�J � Certified Tester(pr�nt) J osl�Ka Cc.v�oa_�Certified Tester(signature) �� Firm Phone# �T 2-Z�i 5�- Z-�7Z Cert.Tester No. RP'oo i► 5 S�-1 Date � - �S-/Lo * 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: CONTACT PERSON/PHONE: , �- q . o - q LOCATION OF SERVICE: SG�M�(n k S I� S-hor qe� , 3zo S,/��... �zl Nor�, The backflow prevention assembly detailed below has been tested��d maint n�d as�required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY 7Reduced Pressure Principle ��Reduced Pressure Principle-Detector i IDouble Check Valve �sDouble Check-Detector ❑Pressure Vacuum Breaker f�Spill-Resistant Pressure Vacuum Breaker Manufacturer E c5�� Model Number SSCv Size 8 �� u►,reKd..bl� eF.teko cowos�oK Located At i„ ��„c r+- Serial Number �-,.�.,.�-H- Is the assembly installed in accordance with manufacturer recommendations andlor local codes? -� =S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air lnlet Check Valve 1 st Check 2nd Check Held at psid Held at psid Opened at Opened at Held at Initial Test Closed Tight;q Closed Tight � psid psid psid po•S5'� Leakedf.] Leaked' I Did not open CJ 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 I 1 ClosedTight❑ psid psid psid Test gauge used:Make/Model Anollo /No zpo Tlr.�u SN: o$o�Zz_.`-t`T , � Date Tested for Accuracy: I I - z3- 1 S Remarks: The above is certified to be true at the time of testing. FirmName��},��,� .�' -r�,�,�s Firm Address�,.�� s, ��d.,,r Q,�4� p,,...ca.1�,•�i��T'�c, 1S�s`t Certified Tester(pr�nt) �asl,�„� l�-••_o„��Certified Tester(signature) Firm Phone#a�z-Za8-2?zZ Cert.TesterNo.aPoou4sy Date �- � S - ((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 PREVENTlON ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: CONTACT PERSON/PHONE: cr �- o� - o LOCATION OF SERVICE: � r ( t►F �-. 3�0 . Hw �z o� coppe The backflow prevention assembly detailed below has been tested and�haintaine �s requ��ire by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY I 1Reduced Pressure Principle �IReduced Pressure Principle-Detector �Double Check Valve �]Double Check-Detector C1PressureVacuumBreaker �-1Spi11-Resistant Pressure Vacuum Breaker Manufacturer FeG�.� Model Number QoS YS Size 3i�I�� Located At��e,.�y e,, S'4ssa�bl,��i� :f'oNozflz�S�y Serial Number l�l oo I oo�d Is the assembly installed in accordance with manufacturer recommendations and/or local codes? x�S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check 1, Held at�psid Held at�� psid Opened at Opened at Held at Inirial Test Closed Tight� Closed Tight Fd psid psid psid as Leaked�l Leaked�i Did not open CJ 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:7 Closed Tight'-7 psid psid psid Test gauge used:Make/ModelAao�lo'�t� zno TK�(,y, SN: pgo'�ZZ`T'z Date Tested for Accuracy: 1 I- 23 ' �s Remarks: The above is certified to be true at the time of testing. Firm Name A,��-o�.�-,'� Sir:,�kl,i o�r j�.,,s Firm Address �i� DN�C'rlNJi �� 1 /�� 1 Certified Tester(print) Jo51�u� L e�.owS Certified Tester(signature) l�� Firm Phone# a`iZ-Z.a�` Z`i`iZ Cert.TesterNo. i�Poo[qS`( Date � - �S- <<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 I.D. #0570040 (Customer) MAILING ADDRESS: CONTACT PERSON/PHONE: � r e - 30 - �Ko cn LOCATION OFSERVICE: Sec.�v��lc SeF�$�r.�- . 3Zo 5. ►rw�lu iUo�}l� �� C. ell TX. T S �q The backflow prevention assembly detailed below has been testp� an�ma�htaine�as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle �7Reduced Pressure Principle-Detector f I Double Check Valve �lDouble Check-Detector �1PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer Fe6� Model Number $S(� Size_g�� Located At ,r.r� .�aW, (-E- Serial Number T=oyo2'�OZ��Iq 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 1,y psid Held at 3,� psid Opened at Opened at Held at Initial Test Closed Tight��,� Closed Tight �� psid psid psid Leaked[ i LeakedCJ Did not open C 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 I J Closed Tight C psid psid psid Test gauge used: Make/Model SN: Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. Firm Name Firm Address Certified Tester(pr�nt) Certified Tester(signature) Firm Phone# 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: 54.�-e- CONTACT PERSON/PHONE: r � � Z -3fl - o � LOCATION OFSERVICE: S�c.Krlo �lc Se� S+-or�,,t , 3Zo 5. H�....+ Izl �Jorkl,� �L The backflow prevention assembly detailed below has been tested and maint'atn d a�s requi�ed by o( � commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY I- Reduced Pressure Principle 7Reduced Pressure Principle-Detector �Double Check Valve �Double Check-Detector CPressureVacuumBreaker JSpill-Resistant Pressure Vacuum Breaker Manufacturer Fp_(�co Model Number S�O Size Z�� Located At i,� q+«►� bo�c �ror.� ..,0.rc�. Serial Number /� 1 ZSIoZ 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 Z•� psid Held at �•� psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight pd psid psid psid ..s Leakedf.] Leakedl I 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 ClosedTight❑ ClosedTight!��1 psid psid psid Test gauge used: Make/Model Anol(m /'-lo Zoo TkS(�t SN: o go�ZZ`['7 Date Tested for Accuracy: i � - Z3 - � S Remarks: The above is certified to be true at the time of testing. Firm Name /-�-�o,�.��,-�,� S,or,l.kle� .�r I ex�SFirm Address 1 S. r �2� � �HNCANV•�� T� ) `I 3`'� Certified Tester(prsnt) J os�r.� Lei...co,.�.s Certified Tester(signature) Firm Phone# °l 12-Z 4$-Z 7`7Z Cert.Tester No. g�vo ��yS�-( Date I- i5- ICa * 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