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RPZ_2015_1023 �IIECI� UNE: IRRIGATION� DOMI�TIC ]�IFt�LINE �,�.., .�_ -- � BACKFT.OW PREVENTION ASSENIB�,1'TES"T ANI)INCA�'TENANCE REPORT Na1v�OF Pws: CITY OF �OP�.�1;�, � m�____�n=�_� PWSI.D.# . MO�� J�tt�' �56� LOCATION OF SERVICE: 7vU �' ��'�" ��P R�� 'Ibe bacl�low pizvmtion asscmbly decailed belor�v has beca t�stcd aud �aintained �s required bv TNRCC reQuladons and is certified to be operating within acccptable paramct�rs. x TYPE OF ASSEMBLY Rcdnced Pressure Principlc c Pressurc�/acu�Brcalcer ^_ Double Check Valve [� �►maosphere Vacuum Breaker 1�2'/ Maaufacturer �^/ y'�I'� Size Model Number �a� Locaud At M'L�' �� ►^'�1�� 5iM � s«��N�b� �6 2$�ld REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Double Check�alve Assembly lst C3eck 2nd CLecl: Rdief�alve alir Inl�t Check Vaive Iniaal Test DGClosed Closed Ti;ht o O�ed at Opeaed ac nsid Ti�t ❑ Leal:ed � 2'�"��sid �osid �v,:,� RP-�psid r� I,�;� �" D i d not O pen o L e a k o d � �P� aad Mataials Usod Test ARet DC-Closed Closed Tight o Opme,d at Opeaed at _e nsid Repair Tight o flsid �sid RP sid The above is catified w be true. Firm Name t41� ��G��" Catified Testa ��1"'�� c-�r� �:� Firm Addrass 2U 1� ��• Cert Testa No. �e W�'��'�S' Date� "�ill tl � '�`( c�auge �k � (�U�GS6� llate last accuracy tested S'�.��.7 VUhite -Customer's Copy Yellow �- City Copy Pu�k --Tester's Copy �IIECI� UNE: IRRIGATION � ll011�E5TIC �xg�� :�r��._�__::�_�-�_�� BACI�LOW PREVENTION AS5EMB�,Y TEST AN�MA�I'I'��IATiCE REPORT NAN�OF PWS: CITY OF' COPI��1;�, PWS I.D. # . MO�,��1' S�1 �{.-C�' �S6� LOCATION OF SERVICE: 7GO �' � �wI'�^ ?(�� R��.`_�...WW_.�_��.—_ �._.... 'Ibe bacl�low preventian asscmbly detailed below has bem uestcd and anaintainod as raquired by TNRCC re�uladons aad is cerdfied to be operating within acceptablc parameters. TYPL OF ASSEMBLY � Reduced Pressure Priaciplc e Pressurt�7acu�Brcaker ^_ Double Check Valve [] Amnosphere Vacuum Breal:er I ''i Manufact�er ��"S Siu �2 Model Iv�ber 0 0 � LLoceated At ��, � � � � s��N�ba � 6Zg�p REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACLnJM BREAI�R Double Check v alve Assembly lst Check 2nd Checl: Relief�atve Air Inlet Check Valve Ininal Test DGClosed Closed Ti;ht d� Oj+enr�at Opened at osid c Ti .� Leal:ed �L�u1 nsid �osid ��j 7 RP�psid �( � L,cal:ed 0 Did aot Opea O L,ea1►e� ❑ �P� and MateriaLs Usod Test Aft,et DC•Closed Closed Tight o Opeaod at Opmed at �sid Repait Tight o nsid osid RP sid The above is certified to be truc. Firm Name t4i) ��" Certified Tester �Gh��'�l j v� La r� e�(:� Firm Address 2U �� R�' Cat Tester No. �e��'��'��' Date� "j�ttl tl � � '1`i Gauge �k � (�U�GS6� llate last accuracy tested S'�L�-�S White - Customer's Copy Xellow - Cit� Copy Pu�k--Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAI�OF PWS: CITY OF COPPELL PWS I.D. # Mq,�� S�l -L� �{S 6� LOCATION OF SERVICE: 7�� `�'U^ T�P Ra � The bacl�low preveation asscmbly detailed below has beea tested aad main ain� � nq� by '�iRCC regulanons aad is cerdfied to be operating withia acceptable parameters. TYPE OF ASSEMBLY � Reduced Pressure Principle � Pressure Vacut�Breaker � Double Check Valve o Atmosphere Vacuum Breaker r ''� Maaufacturer `►J(/�� Siu �1 Modellvumber d d Q LocatedAt �� `��'(,��, (,��►,��- S!�K Serial N�ber �� 7�.�S REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check Valve Assembly lst Check ?nd Checl: Relief Valve Air Inlet Check Valve Inival Test DGClosed Closed Tight � Opeaed at Opeaed at �id Ti�t ❑ Leal:ed � �,_psid _osid ��"y� RP-.�psid � I,�;� � Did not Opea o 1,eai►ed � �P� aad Mataials Used Test Aft,er DC•Closed Closed Tight o Opeaed at Opeaed at _nsid Repair Tight o osid osid RP sid The above is cerafied to be true. Firm Name tdt tl ��" Catifiad Testa 1��1��h L°�r� �Y� Firm Address 2U 1� R�� Cert Tester No. �e��'��'�S' Date�� -�ll tl � '�`� Gauge # �f (�U�GS�� llate last accuracy tested S'��j White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK UNE: IR.RIGATION DOMESTIC � FIRELINE BACI4'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT rr.�1�OF Pws: CITY OF COPPELL PWS I.D. # M �l,U J1.�{�' J��-L� �S� LOCATION OF SERVICE: 7Gd �' O L�'�-�"� ^ ��,,P R,�. The bacl�low preveation assembly detailod below has baa tested aad maintained as required bv TNRCC re_¢uladons aad is certified to be operating within acceptable paramtters. TYPE OF ASSEMBLY DC Raluced Pressure Principle ❑ Pressurc Vacu�mm Breaker � Double Check Valve ❑ Aunosphere Vacuum Breaker i�,�., Maaufactiaer �°�� Siu Model Number v d� Located At U �•� ''�� Sezial N�ber A�Z70� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check v alve Assembly lst Check 2nd Checl: Relief Valve Air ldet Checic Valve Inival Test DC•Closed Closed Tight � ed at Opened at nsid �� Ti�t �. Leal:ed 0 �' sid osid o RP- '�0 psid � \ �;� 0 7�� Did not Opea o Leat►ed o �P� and Materials Used Tesc Aft,er DC-Closed Closed Tight o Opened az Opea�at _nsid Repair Tight o nsid osid RP sid The above is cerdfiod to be we. Firm Name ��I I Z-�� Cerdfiod Testc ��✓4��i✓� G`'�-r�' �-1'-tt�' Firm Addrass n°�� '�_ Cert Testc No. \0��6`I-�C� D� d'�-�'�S �,2,�I U( ��`" y�l �� Gauge # 6�47� llate last accuracy tested ��'� �' White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC FIRELINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINI'ENANCE REPOR? NAME OF PWS: CITY OF COPPELL PWS I.D. # � Gl,�� '�"�2�"�' �S�''� LOCATION OF SERVICE: 7UG :�1,) �� V� ��1 �.�• The bacl�low preveation asscmbly derailed below has beea itsted and ma�ntain� � nq�� by TNRCC regulations and is cerdfied to be operating within acceptable paramcters. TYPE OF ASSEMBLY � Reduced Pressure Principlc ❑ Pressure Vacuimm Breaker ^_ Double Chxk VaIve a Atmosphere Vacuum Breal:er � � Maaufaca�er w�� Siu �Z - Model Nimmber �� Located At 5�.•� n P�+� 1,�,`��t,Y S�h� Serial Nimmber � � REDUCED PRESSURE PRINCTPLE ASSEMBLY PRESSURE VACUUM BREAI�R Double Check Valve Assembly lst C3eck 2nd Checl: Relief Valve Air Inl�t Check Va1ve Inival Test DGClosed Closed Ti�ht �° Open at Opened at osid Ti � Leal:ed ❑ �'� osid osid �SS ��G ps�a �-k \ L,eal;ed ❑ v Did not Opea O Leal:ed � �P� and Materials Used Test ARer DC-Closed Closed Tight o Opeaed at Opeaed at _osid Repair Tight ❑ �sid osid RP sid The above is cerdfied to be true. Firm Name � �� Y'Q.C�' Catifiod Tcsta ��,�-lti i`� C��l � Firm Address (��5 1�(�-+l i R� Ccrt. Testc No. �PUl16t�� Date(d-Z��)) ��U�eX ,X �7(o�`�� (=auge # 4 �iU�QS�`� llate last accuracy tested S 2�� White- Customer's Copy Yellow - City 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 far recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) 1 p MAILING ADDRESS: 7 S6 Or,�^�I I �,1 1�G CONTACT PERSON/PHONE: !'^�h� t� q- 1 l - LOCATION OF SERVICE: �.v�� -c. �r- tr (v�Q.r $� 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 ��Reduced Pressure Principle-Detector C Double Check Valve � !Double Check-Detector ' IPressureVacuumBreaker �Spill-ResistantPressureVacuumBreaker Manufacturer w �� Model Number d dq M ti Size �ff Located At �� r�� ' ' Serial Number � �) ��3 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? GS 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 Tig1-r�(I Closed Tight� psid psid psid Q�`�`� Leakedf i LeakedC'� Did not open I-� Did not open CJ Leakedl '� Repairs/ Materials � Used Held at psid Held at psid Test After Opened at Opened at � Held at Repair Closed Tight� 1 Closed Tight'�� 1 psid psid psid Test gauge used:Make/Model `''r�`ly�S ��"S SN: ��7�� Date Tested for Accuracy: S� ZO�)5 Remarks: The above is certified to be true at the time of testing. FirmName ��1�� Firm Address ��G'°S ��'`� �� `'11� ��' 1621I�� Certified Tester(print)�U"�'�H �-��'�Certified Tester(signature) � -/(�� Firm Phone# O� �y��5� Cert.Tester No��'Z�6 Date 1 C��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 C�IECK ONE: IR.RIGATION DOMESTIC i�, FIBELINE BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINT'ENANCE REpORT N�oF Pws: CITY OF COPPELL PWS I.D. # ��.�� S�'��.-�� S G�� LOCATION OF SERVICE: 7S� 1� �� -�P ,P`c�' The bacl�low przvmtion assembly decailod below has beea tested aad maintained as required b" TNRCC reguladons and is certified to be operating within acceptable parametars. TYPE OF ASSEMBLY ,�.. Reduced Pressvre Principle ❑ Pressure Vacu�Breaker � Double Check VaIve ❑ Amnosphere Vacuum Breal:er 1 �i Maaufactiaer � r^-� Siu � Z Modei Number 4 Cl � Located At SfiGf�� R,M �, -7 Z�l 1 � Scrial N�ber REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VAC[TUM BREAI�R Doubie Check Valve Assembly lst Check lnd Checl: Re(ief Valv� Air Inlet Check Valve Inival Test DGClosed Closed Ti�t� e�at Opeaed at �sid Tight � Leal:ed ❑ �osid _�esid �� R.P-�1 psid � �� Leal:ed ❑ �' Did not Opea o Leai;ed O �P� aad Mataials Used Test After DC-Closed Closod Tight o Opeaed at Opeaed at nsid � Repair Tight o �nsid _osid R.P sid The above is cGrtifiod to be true. Firm Name �+� TCS� Cctified Testa 1��-�1�J�r��►� ��Y�"��1- F�aaa��2��s ��► t� '�v�\�r� c«t. r�xo. (��' udi 6�� D� '�� =Z3—�s c�suge # 0 6 o7(�6Zj llate last accuracy tested 5��0 5 White- Customer's Copy Yellow - City Copy Pink-Tester's Copy C�iECK ONE: IRRIGATION DOMESTIC C FIRELINE BACI�'I.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REpORT NAME OF PWS: CITY OF COPPELL PWS I.D. # ,�c��c-�-� ��-r-e-�—� ��6�) LOCATION OF SERVICE: 7 G d J" � �'►�`� I �'p �� ' The bacl�low prevtation assembly detailed below has bxn tested aad maintained as required b�, TNRCC reguladons aad is cerdfied to be operating within acccptablc paramcters. TYPE OF ASSEMBLY � Reduced Pressure Principle � Pressure Vacu�Breaker ^— Doublc Chxk Valve o Atmospherc Vacuum Breal:er . Z/'.� Manufact�aer 1''�� Siu ) Model Number � �� Locaud At ��G�,G�- G�.�' ��'��°�� Serial N�ber � �Z�o-S S y r In..p G�,1t 1 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Cbeck v alve Assembly lst Check 2ad Checl: Relief Valve Air Inlet Checit Valve Inival Test DGClosed Closed Ti�t � Opeaed at Opeaed at �sid Tight � Leal:ed ❑ 2 "0 psid _�osid ,n �� R.P- S��sid ]I[ Leal:ed o S.�� Did not Open o Leal:ed J � �P� and Mat,erials Usod Test After DC•Closed Closed Tight o Opeaed at Opeaod at _esid Repair Tight ❑ �nsid __nsid R.P sid The above is cerdfied to be true. , Firm Name�t I� �C.f� Catified Testa �`eN�lU`MiY1 G GJ�-Q��' Firm Address�1 G 6S �� Cert. Tester No. ��)d�6Z��D Date �� Z��IS '�¢,t�tY ) x � Gauge # 0(�U 7a�(�� Date last accuracy tested � - �`�� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IRRIGATION DOMESTIC \ FIRELINE BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPOR? NAI�OF PWS: CITY OF COPPELL PWS I.D. # r��.r�-�� S�-�r�-c�-� � 6�� LOCATION OF SERVICE: 7 V � � tti �G� I � �c� The bacl�low prevention asscmbly detailed below has beea tested aad maintained as required b�, TNRCC regulations and is cerdfied to be operating within acr.eptable parameters. TYPE OF ASSEMBLY � Reduced Pressure Priaciple � Pressure Vacuimm Breaker ^ Double Check VaIvc ❑ Amnosphere Vacuum Breaker Manufactiaer �� Siu � ''/ Model Ivumber �� Located At �� I'��° �'� ' Scrial N�ber � 3 OC� REDUCED PRESSURE PRINCIPLE ASSEMBLY PR�SSURE VACUUM BREAKER Double Check Valve Assembly lst Check 2nd Checl: Relief Valve Air Inlet Check Valve Ininal Test DGClosed Closed Ti,Pht �f. ed at Opened at _nsid Tight Leal:ed � � • sid _�nsid RP-� y"�' psid � Leal:ed o �"� Did not Opea O Leal:ed o �P� aad Materials Usod Test ARer DC-Closed Closed Tight o Opened at Opeaed at _osid Repair Tight ❑ osid osid RP sid The above is certifiod to be true. , Firm Name �'I�( I��' �/Certified Testa ��JG�h��l� C�t�r.� Firm Address 2o GS � �,�.��1\mf�rCert. Tester No.l�I GO I 6�6 Date �G`�'��S (3auge # �j(��C)�� llate last accuracy tested �-1'°_I S White - Customer's Copy Yellow - City Copy Pink-Tester's Copy