The URL can be used to link to this page

RPZ_2015_0922 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: � � � / C� � � CONTACT PERSON/PHONE: Op LOCATION OF SERVICE: S�� e The backflow prevention assembly detailed below has been tested and maintained as required by commission regularions and is cerrified to be operating within acceptable paraineters. � TYPE OF ASSEMBLY �7Reduced Pressure Principle ��Reduced Pressure Principle-Detector I Double Check Valve ' I Double Check-Detector �PressureVacuumBreaker ';Spill-Resistant Pressure Vacuum Breaker Manufacturer � � � Model Number ��T 2 Size�� Located At j- !�S"L y 1rU�,vJ L��G T / Serial Number f�L� ��D ? 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 �Q psid Held at�psid Opened atv�� Opened at Held at Initial Test Closed Tightf/� Closed Tight � psid psid psid Leakedf I LeakedC Did not open I �� 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'�� Closed Tight f:i psid psid psid Test gauge used: Make/Model ,�G��G' I' � �-S SN: d g(�1,/��'�� J � T Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. Firm Name /��G�Yc� �U/YI Yd� � Firm Address�Q��%��C>-Yc�y�Cv��C 7��'f� Certified Tester(�rint) � �/'y ' ��10" Certified Tester(signatur d!�� Firm Phone#�7,2��l�7� Cert.Tester No_��(��Q�''f' 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAiNTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) �� MaiLiN� aDD�E : �'1/� C ,�e��'�y��c.� '7SLlq CONTACT PERSON/PHONE:��y�,_�7� ge� oDa(� LOCATION OF SERVICE: ��,y��► 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 �7Reduced Pressure Principle '�Reduced Pressure Principle-Detector f-�Double Check Valve I Double Check-Detector ClPressureVacuumBreaker �� Spill-Resistant Pressure Vacuum Breaker � !l Manufacturer ,,✓��.�s Model Number �a�dh�r� Size�_ Located At ��S�'r�''pUj�1 �/�'�� Serial Number �� 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��l�psid Held a��/- psid Opened at,�� Opened at Held at initial Test Closed Tightf� Closed Tight `� psid psid psid Leaked�1 Leakedl '� Did not open I ! Did not open �� I Leakedl Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight_1 Closed Tight'_ I psid psid psid Test gauge used: Make/Model �i ��5��,��-� SN: ��f�/1�,/(� �.�1.� Date Tested for Accuracy: �' ��'S //f`' Remarks: The above is certified to be true at the time of testing. FirmNamep�'!P1'-�'v �U,rr7/�, Firm Address��/.Z(/7��-r�lD�'Vi'f�G�?�7�y� Certified Tester(print) � 'r✓ � C �� Certified Tester(signature)� �� Firm Phone#�7�� (7� Cert. Tester No.��DU�� 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPP LL PWS I.D. # 0570040 (Customer) �'q, ' Yc Jti MAILING ADDRESS: � � I�� J y„� �� 7 �p� C� CONTACT PERSON/PH�NE: �'Yj„ �y'. �7� �!�("p �s p��„ LOCATION OF SERVICE: ,�"'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 educed Pressure Principle 1Reduced Pressure Principle-Detector I Double Check Valve 1 Double Check-Detector ❑PressureVacuumBreaker i Spill-Resistant Pressure Vacuum Breaker � // Manufacturer ��,j Model Number ��,2 Size� Located At Y�'oS'"2 �` r r�om /��3 Serial Number�� !�l.�' � 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 a��psid Opened at� Opened at Held at lnitial Test Closed Tightf:� Closed Tight �I' psid psid psid Leaked� I Leakedf�1 Did not open I'� 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_J Closed Tight'�� I psid psid psid Test gauge used: Make/Model /�"!�!�/�✓�'S 1'� ��.S� SN: � 34'y�? �� Date Tested for Accuracy: /�/S�� ' Remarks: The above is certified to be true at the time of testing. Firm NameJ�(;�'Y'D 1�,� Firm Address dC� �i� �l' �vl G /!C �� Certified Tester(print)� Q �l'��(��Certified Tester(signature Firm Phone# �� 7�� Cert.Tester No �g 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: �', � �' �/1 � G �' CONTACT PERSON/PHONE: o LOCATION OF SERVICE: S� ,n e 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 - educed Pressure Principle [ Reduced Pressure Principle-Detector � 1 Double Check Valve [1 Double Check-Detectar iPressureVacuumBreaker f�Spill-Resistant Pressure Vacuum Breaker /i Manufacturer�,�,e,f �f S Model Number �L,�1 �j�2 Size_� Located At �� f'C'r +'�Van1�l�' ��7' Serial Number/� �/ '/ � 7 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e. 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� I Closed Tight I ! psid psid psid Leakedf Leaked. I Did not open� Did not open . l Leakedl ' Repai rs/ �Q¢�JC�.CG Materials Qir-p!LN/i s��A'! Used Held at i psid Held a �' psid Test After Opened at��Z Opened at Held at Repair Closed Tight� Closed Tight f'� psid psid psid Test gauge used: Make/Model o"/i� G�r'S�� SN: ��C3 �jjf � Date Tested far Accuracy: r S Remarks: The above is certified to be true at the time of testing. FirmName,�� f� �U h'U�'J Firm Address��/,��7 ��I��V`G�� Certified Tester(print) � E.� ' � �� Certified Tester(signature) .� � z��----- Firm Phone# � � U l/�L� Cert.Tester No /��LF.�1�f�� Date ��22 �� -� * 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 � IRRI V GATION 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) / MAILING ADDRESS: ,�,f��y�n 17 l 7 � G�¢�il'1c ��il �.S��rf' CONTACT PERSON/PHONE: !�l/1��'' 7� 9 C!� (j(rUl� LOCATION OF SERVICE: S'�� 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 educed Pressure Principle C=Reduced Pressure Principle-Detector -]DoubleCheckValve ❑Double Check-Detector ' 'PressureVacuumBreaker ` ISpill-Resistant Pressure Vacuum Breaker 1� Manufacturer y�/�,�Gt �"S Model Number �� Size�_ Located At__�' �rSC Y rQ p yn ,�j��CB 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 1 st Check 2nd Check - Held at psid Held at psid Opened at Opened at Held at Initial Test Closed Tight 1 Closed Tight I�� psid psid psid Leaked��1 Leaked� I Did not open!� Did not open �� I Leaked'� Repairs/ ��l�c� Materials /�rUf«y�,�'�r.�,r� Used Test After Held at � � psid Held at � psid Opened at 2� � Opened at Held at Repair ClosedTight,�' ClosedTight'�rf' psid psid psid Test gauge used: Make/Model/�1'�j�f�'�'7' ��`J SN: `J y�J 1/(1 �j Q Date Tested for Accuracy: 1 �,S �/S � Remarks: The above is certified to be true at the time of testing. Firm Name/'�/�' ��'0 �('Z�'h �✓1 Firm Address��L'3��p� �Yi..y��j�y�6�� Certified Tester( r;n C,t � � Certified Tester(si nature � p t r�. . L Do g ) Firm Phone#�72 G�� 7 (�� Cert.Tester NoJ�/��7 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 1.D. #0570040 (Customer) MAILING ADDRESS: �� /��y�,�� l�/ 7 � l�,1 j�-�� GQc,� 7 S!J!� CONTACT PERSON/PHONE: ✓1�lr. 7�� L1 �')(��/'� LOCATION OF SERVICE: �,��G 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 �'keduced Pressure Principle I ��Reduced Pressure Principle-Detector :I Double Check Valve I I Double Check-Detectar �PressureVacuumBreaker f iSpill-ResistantPressure Vacuum Breaker �1 Manufacturer��'t"�' � Model Number��(��j/�� Size�_ Located At '�''�� { �/'}(�?'L,l/7/��/ Serial Number�� J�/� Is the assembly installed in accardance with manufacturer recommendations and/or local codes? G 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 a�psid Opened at� Opened at Held at Initial Test Closed Tightli' Closed Tight � psid psid psid Leakedl�I Leakedl I Did not open �.�1 Did not open f�. Leaked�� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair C]osedTight'�_l ClosedTight I psid psid psid Test gauge used: Make/Model,�ilif�C✓��5�� SN:6 ��,SQ Date Tested far Accuracy: ��yS� �J,S Remarks: The above is certified to be true at the time of testing. Firm Name��I� (_,C�JYI �2'1 Firm Address �P C' r� � a Certified Tester(print�Y 1'y ��f?�1O�. Certified Tester(signature Firm Phone#�/�� ,��7�� Cert.Tester No��r�l 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 v The following form must be completed for each assembly tested. A signed and dated original 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 I.D. # 0570040 (Customer) MAILING ADDRESS: s � /' L'✓ ,., � l� C " � i " CONTACT PERSON/PHONE: � a LOCATION OF SERVICE: rn 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 �duced Pressure Principle �1 Reduced Pressure Principle-Detector ��1DoubleCheckValve -�1Double Check-Detector ��PressureVacuumBreaker ��-Spill-Resistant Pressure Vacuum Breaker I l � Manufacturer / �'� ��Model Number �)_�__�� Size� Located At ��, r a � G Serial Number � � .-�� l� ��..�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes?�� S Reduced Pressure Princi te Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air lnlet Check Valve 1 st Check 2nd Check Held at�psid Held at r J psid Opened at, � r� Opened at Held at Initial Test Closed Tight�-r Closed Tight� psid psid psid Leaked 1 Leaked' J Did not open I I Did not open � I Leakedl �� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight� I ClosedTight��I psid psid psid Test gauge used: Make/Model � SN:`� fif</�f1� �G Date Tested far Accuracy: / � ,� Remarks: The above is certified to be true at the time of testing. FirmName��y�r0 ��rh�'I_ Firm Address�OJ�Z�p, �y�l��j�V/`G,�� Certified Tester(pr;nt) , Y�' Ol�'� Cerrified Tester(signature Firm Phone#��L9„��L7 Cert.Tester No. �J,�d�j f{��Date �2 * 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 V The following form must be completed for each assembly tested. A signed and dated original 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 I.D. #0570040 (Customer) MAILING ADDRESS: �1; /�ar,'11 �7�� /,�/,h r �P� 7SG � �' CONTACT PERSON/PHONE: �y,T,�� ,��(,f�� LOCATION OF SERVICE: ��y►� C 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 �duced Pressure Principle I 1Reduced Pressure Principle-Detector f I Double Check Valve ❑Double Check-Detector C�PressureVacuumBreaker ' 1Spi11-Resistant Pressure Vacuum Breaker (� 9/ Manufacturer� ��_Model Number �� 7��— Size � Located At �Y'd'6 �f C ��Do/t'1 ��'� Serial Number�� 3� I 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�ps d Opened at i� Opened at Held at Initial Test Closed Tight� Closed Tight� psid psid psid Leaked 1 Leakedl ' Did not open l Did not open ❑ Leaked' i Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight I � Closed Tight��,�I psid psid psid Test gauge used: Make/Model �� ` � SN: � $(J �Q��11 Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. Firm Name �"��/'c+ ��}' �/ Firm Address�U��7�'�.,��f%y� �tT��(�``3/ Certified Tester(pr�int)� ' Certified Tester(signature � / - Firm Phone# � �� c� l �� Cert.Tester No �i Date l�2 J � * 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 V 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: , ;� / �� Jj��ihG S��j CONTACT PERSON/PHONE: n �', % � L�CJ4 LOCATION OF SERVICE: ��y� ,� 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 �duced Pressure Principle �IReduced Pressure Principle-Detector �iDoubleCheckValve -1Double Check-Detectar� ❑PressureVacuumBreaker �1Spi11-Resistant Pressure Vacuum Breaker Manufacturer /��i_�'S Model Number Q� Q �� Size�� Located At � " Y ro6�� Serial Number�6 .Z,�, �G.4 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 TightriY Closed Tightr} psid psid psid Leaked� Leaked.�1 Did not open [1 Did not open I I Leakedf I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight-J Closed Tight� psid psid psid Test gauge used:Make/Mode1/-��h/CS� �y�� SN:Q�G� ��.S� Date Tested for Accuracy: l�/s /J� Remarks: The above is certified to be true at the time of testing. Firm Name �Q tI�l� �G�� Firm Address �U��2G7�f�crr'�►� �x' 7�a 9/�' Certified Tester(pr�nt��'✓'y�e�� Certified Tester(signatur � Firm Phone#��,'� �� 7�� Cert.Tester No��Q�� 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) . MarLING a��REss: t � �i� ,��hc G i CONTACT PERSON/PHONE: J✓l (1 f� " LOCATION OF SERVICE: .SC�� 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 l�educed Pressure Principle f 'Reduced Pressure Principle-Detector I 'DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker I� ISpill-ResistantPressure Vacuum Breaker / � �/ Manufacturer L/' .� Model Number �C�C/- �J�,'j, Size�_ Located At ,1'" �''�(r Y �/'0��5 #22. Serial Number�J� �S� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �Q 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 �i�psid Held at��psid Opened at �� Opened at Held at Initial Test Closed TightG�' Closed Tight !�'' psid psid psid Leakedl 1 Leaked�. 1 Did not open �-1 Did not open .-1 Leaked�� Repairs/ Material s Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight C�: Closed Tight��I psid psid psid Test gauge used:Make/Model �'�1��,� SN: � ��lU� ,s� Date Tested for Accuracy: �/l/ ,�� S Remarks: The above is certified to be true at the time of testing. Firm Name ��() �C��f Firm A ddress�d�l��U'!!�/J�i/� ��/ Certified Tester(prin � Certified Tester(signature � � Firm Phone# 712 �� Cert.TesterNqtS�� Ql��}��ll� Date �,Z� � * 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 ADD�SS: _S� /�/J�,,,�,',� �� 1� � �3� 1�-�✓,�c ,��Q � �a /� CONTACT PERSON/PHONE: �'✓1 n�,y, �j �', �'�(, �5�' S Gr LOCATION OF SERVICE: e5'�G�� 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 C�'Reduced Pressure Principle CReduced Pressure Principle-Detector ❑Double Check Valve Ci Double Check-Detector ��Pressure Vacuum Breaker ❑Spill-Resistant Pressure Vacuum Breaker !l Manufacturer� Model Number l.�/) g�� Size � � �/' 2, J Located At �I �1r 1�`U�1� �v�9' �� ✓ Serial Number /,�1 �� . � 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 Tightl� Closed Tight ��.�'' psid psid psid Leakedf '� Leaked� I Did not open -] Did not open ' 1 Leaked�� Repairs/ Materials Used Test After Held at psid Held at psid Opened at Opened at Held at Repair ClosedTight❑ ClosedTight I�I psid psid psid i Test gauge used: Make/Model�9' ��n,�f`� SN: (�`d (�Gf G��-rj S L� Date Tested for Accuracy: ��,S �� Remarks: The above is certified to be true at the time of testing. Firm Name� �f-�U �Q CLl� Firm Address�l /�G��i,r�G'I/r G �� Certified Tester(pr�nt��r P��Q�p � Certified Tester(signature Firm Phone# ��[�,z�_��'L' Cert.Tester No� �Q g Date 2�- � * 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: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: �% � r , � � re� � CONTACT PERSON/PHONE: n LOCATION OF SERVICE: �'�� 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 �educed Pressure Principle CReduced Pressure Principle-Detector C��Double Check Valve f��Double Check-Detector CPressureVacuumBreaker C�:Spill-Resistant Pressure Vacuum Breaker n� �� Manufacturer �``� Model Number ��/_L,� Size� Located At�/�a G Y ��J�� 7 Serial Number�� / q Is the assembly installed in accordance with manufacturer recommendations andlor local codes? G.f 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 Tightl� Closed Tight � psid psid psid Leaked�1 Leakedl I Did not open l 1 Did not open f J Leaked�� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight��l ClosedTight I I psid psid psid Test gauge used:Make/Mode ��G✓� � �.s" SN: a�sc� yr�s�s� Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. Firm Name��I d �!!�'y(/i'1 Firm Address �6��(D/�Gy�V'/✓ICT ��9� Certified Tester(pr�nt��r Certified Tester(signature 2 Firm Phone#��i� g 7�� Cert.Tester No��7 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 LD. # 0570040 (Customer) � � � MAILING ADDRESS: �-_ ,�'i/7 L� �'' � C � CONTACT PERSON/PHONE: LOCATION OF SERVICE: ' L� 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 l�l�educed Pressure Principle �Reduced Pressure Principle-Detector -1DoubleCheckValve ��Double Check-Detector -1PressureVacuumBreaker f 'Spill-Resistant Pressure Vacuum Breaker , �� l� Manufacturer �,5 Model Number � � Size Located At � �° � v p �/ �� Serial Number �,�1 � � 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�psid Held��psid Opened at I� Opened at Held at Initial Test Closed Tight�'"� Closed Tight � psid psid psid Leakedl 1 Leaked C' Did not open �.1 Did not open '�� I Leakedl �� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�] Closed Tight C'� psid psid psid Test gauge used: Make/Model ��G( �C' r��j `s SN:�/�g,�� Date Tested for Accuracy: „J� /� Remarks: The above is certified to be true at the time of testing. Firm Name �J�!'Q C�,yl�?/� Firm Address��(!/UYc./��I,''i�G�/�i�1/`� Certified Tester(prant�Gr Y��/C 6o K Certified Tester(signature .� Firm Phone#��(„P D 7�� Cert.Tester No!,J�I��,JI��.It(a� 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