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RPZ_2016_0120 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: 3O fL'� C; � �l� Ix 75�� CONTACT PERSON/PHONE: L � ' � � (a— �/b LOCATION OF SERVICE: 5� �� h 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 ��rReduced Pressure Principle -1Reduced Pressure Principle-Detector i�DoubleCheckValve -1Double Check-Detector CPressureVacuumBreaker -1Spi11-Resistant Pressure Vacuum Breaker i� Manufacturer �t �� Model Number 3 �S Size �+�Z Located At UJ, �LTiZ Serial Number L ��' f Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e�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 �0'� psid Held at psid Opened at Z�Z Opened at � Held at Initial Test Closed Tighti; Closed Tight �� 1 psid psid psid Leakedl '�� Leakedl-1 Did not open �� Did not open f 1 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 �M�/'�� `�8'z� l� SN: ZSgODO Date Tested for Accuracy: �— �� — �o �5 Remarks: The above is certified to be true at the time of testing. FirmName � �� Firm Address �� ' �T �� Certified Tester(print) �J �(� 1� Certified Tester(signature) � � Firm Phone# Z�� '`� ll� "��/�"b Cert.Tester Na � 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: �3�� rQ ��Er' �� fl � "'r rja CONTACT PERSON/PHONE: (,e:�1 S `aS LOCATION OFSERVICE: (�5 • oe 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 y�IReduced Pressure Principle I Reduced Pressure Principle-Detector i-�DoubleCheckValve ��1Double Check-Detector '�IPressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker �r Manufacturer �A�S Model Number �� 3 �' Size � Located At �� ZZ Serial Number 2 j� 7�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �5.5 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 3• �` Opened at Held at Initial Test Closed Tight 1 Closed Tight ��l psid psid psid Leakedf�1 Leaked�l Did not open ' I Did not open i�_ Leaked��I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight��_l Closed Tight�1 psid psid psid Test gauge used: Make/Model �M�rU.C� �O-�vO-n� SN: ZS�rj�b Date Tested for Accuracy: �1/�(�� S Remarks: The above is certified to be true at the time of testing. Firm Name l�T(,'�I ..1- � Firm Address ��JO� ( �pj� ��yr, Certified Tester(pr�nt) U I Certified Tester(signature) t�y Firm Phone# �,�'��' Q�tu Cert.Tester No. f��O�S� Date 1 � ��° * 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 1RRIGATION 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) i MAILING ADDRESS: ' P�� T�, ��'�� CONTACT PERSON/PHONE: LeLv�'S � S Z� — 6—80 b LOCATION OF SERVICE: (�5 � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is cerrified to be operadng within acceptable parameters. TYPE OF ASSEMBLY �educed Pressure Principle �Reduced Pressure Principle-Detector �� `Double Check Valve -1 Double Check-Detector CPressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker Manufacturer wQ"I�T Model Number �� Qr Size3�� Located At �� ZZ� � 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-�I Closed Tight I � psid psid psid Leakedl � Leaked� 1 Did not open . I Did not open � �� Leaked'� I Repairs/ (�,r�r��e-�'�r ��b� Li-� Materials Used Held at r psid Held at psid Test After Opened at �•� Opened at Held at Repair ClosedTight 1�1 ClosedTight� psid psid psid Test gauge used: Make/Model�m F�r0.�� d'- �'�� '� SN: Zs�1p0 Date Tested for Accuracy: C( � �� Remarks: The above is certified to be true at the time of testing. , FirmName �A�� Firm Address f�JQJ� 11 � i+� � ' Certified Tester(print) Certified Tester(signature) Firm Phone# �� "��b�U�`rb Cert.Tester NodJl �� 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