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2016_0125 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: CONTACT PERSON/PHONE: LOCATION OF SERVICE: Z1 S� 21�-T�6�-- 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 ��R duced Pressure Principle ❑Reduced Pressure Principle-Detector ouble Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker ;�� Manufacturer � � Model Number �� Size-��.T� Located At f�� ti Serial Number �� 3 7 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�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight��_ � Closed Tigbt �� psid psid psid Leaked❑ Leaked❑ Did not open Ci Did not open CJ Leaked❑ Repairs/ Materials Used Test After Held at psid Held at psid Opened at Opened at Held at Repair Closed Tight❑ Closed Tight L psid psid psid Test gauge used:Make/Model (�Jiv� �� SN: ��7 V�l� Date Tested far Accuracy: r��3�l S Remarks: The above is certified to be true at the time of testing. Firm Name ��i/°''12-1'�- � Firm A ddress �� YJ2 �_U��''�1 � X �� Certified Tester(pr�nt) � ��-Rfl Certified Tester(signature) Firm Phone# % 7 Z ��v� �� Cert.Tester No. , � ��`S Date l—2 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 GANDARA IRRIGATION INC. 3901 Clifton Dr. Richardson TX 75082 Office: 972-671-3776 Fax: 972-664-9158 Cell: 972-467-3918 Email: eddiegan1@sbcglobal.net 921 SARATOGA BELMONT LANDING COPPELL TX To Whom it May Concern; An irrigation system was installed at the property described above. In accordance with the city of Coppell inspection requirements, we are providing the following information. This irrigation systemhas been installedin accordance with all applicable State and local laws,ordinances,rules,regulations and orders. I have tested the system and determined that it has been installed according to the irrigation plan and is properly adjusted for the most efficient application of water at this time. 1 year warranty from the day of installation. Sincerely EDWARD GANDARA : ,� ?�,^��~�5��` Z.' ?D! Scn r'�; •7°: � :O ( / _ �t c��.�:�,�;. :.t, � 10 : c;;:�:. .j : � • �+y` • ~ J� �C�••. :D+ r�}m k '9l�•....��••*�