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RPZ_2016_0121 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: 1303 �� C,`r� � � 50I CONTACT PERSON/PHONE: I-�W I� iµ- -SD�O LOCATION OF SERVICE: �C�p /Y�pG/��h 9 ,r n, The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable para�neters. / TYPE OF ASSEMBLY �Reduced Pressure Principle ,Reduced Pressure Principle-Detector I Double Check Valve I �Double Check-Detector �IPressureVacuumBreaker I ��Spill-Resistant Pressure Vacuum Breaker ` � p i� Manufacturer l,�a s Model Number (�� , Size � (�Z, Located At 1��1 ��O l.��JSTQ�Y'S Serial Number �3�J��v 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 �O'� psid Held at psid Opened at 3`� Opened at Held at lnirial Test Closed Tight� Closed Tight ��1 psid psid psid Leakedf'�� Leakedf�'� Did not open I �� 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'.J ClosedTight I I psid psid psid Test gauge used: Make/Model�M�r��t� �p-- ZO D 'r�G SN: �5 ��v Date Tested for Accuracy: ��f�/5 Remarks: The above is certified to be true at the time of testing. I .�s1� � FirmName� ��4t�'e � Firm Address �3C� I�Q � f w Certified Tester(pr�nt) U1 Certified Tester(signature) Firm Phone# ��T �"7 �� l�/ Cert.Tester No.��Date � �� b * 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 far recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: 30 r n �r i' �� lX CONTACT PERSON/PHONE: �W�"S ��!- 4 a(o— � v LOCATION OF SERVICE: �rjn Mar1u"/tql�i ,Cn 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 I�Reduced Pressure Principle ❑Reduced Pressure Principle-Detectar �-lDoubleCheckValve �Double Check-Detector ❑PressureVacuumBreaker CSpill-Resistant Pressure Vacuum Breaker ;� Manufacturer � fF'T f 5 Model Number DD9 m � Size � ��Z Located At��/}CL LuS�o',F}T� C�.05�i Serial Number ��3 2 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? `�eS 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 C'� psid psid psid Leaked'.] Leaked❑ Did not open I�� Did not open I.l Leakedl Repairs/ �d,�.A,l. �h �, Lj,�. Materials Used Held at 6 psid Held at psid 3,(o O ened at Held at Test After Opened at p Repair Closed Tight� Closed Tight❑ psid psid psid Test gauge used: Make/Model�m�ratt� �- Zo0�K SN.7,S$DOU Date Tested for Accuracy: 9�/� I(� Remarks: The above is certified to be true at the time of testing. Firm Name LoP�J�� s� �� Firm Address 1303 f�han IP.v U��"� Certified Tester(print) I G i � Certified Tester(signature) � Firm Phone# ZI`�—�9�o'�i��U Cert.Tester No.��7s� Date �' z�` �� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS R�� 2-�s rb **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) n, n MAILING ADDRESS: �3�3 W�'a►'� I er��• l� I� j� 7 S�1 �� CONTACT PERSON/PHONE:Le.u�t S ' r4 —4 � -- U LOCATION OF SERVICE: DD (�° ,(� ' �/�. 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�educed Pressure Principle ❑Reduced Pressure Principle-Detector �J Double Check Valve ��l Double Check-Detector '-7PressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker L/ � .r Manufacturer Q7Ts Model Number 909 rn � Size � �Z Located At�(��f�</ Q.U5�1"Oo�ai/ C�OS�� Serial Number ��S�j / Cf 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 Neld at Initial Test ClosedTightf� Closed Tight I �� psid psid psid Leaked. 1 Leaked`1 Did not open ��l Did not open I ! Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight� 1 ClosedTight .I psid psid psid Test gauge used:Make/Model ��'►'1 b��Cc� 7'O" a 0�� SN: ZS'g000 Date Tested for Accuracy: ��$� /$— Remarks: The above is certified to be true at the time of testing. Firm Name�1�l�1 I �S� Firm Address �30� Wl12 � ir. Certified T'ester(print) 9JC�V I I...C�i� Certified Tester(signature) � Firm Phone# ��`7'—`( /l�r O�`t� Cert. Tester No. ��(/0�7� Date �'d2�� * 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