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2016_0505_RPZ 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) MAILINGADDRESS: 13 �� '��S'�C. �,r' Co ��-C�� T � CONTACT PERSON/PHONE: �I'1 Z, l{"] 1 ��• � LOCATION OF SERVICE: �3 3 3 Lr-cf� i c+� �( o ��-�- �( T-x 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 IDoubleCheckValve �-1Double Check-Detectar 1PressurcVacuumBreaker '��1Spill-Resistant Pressure Vacuum Breaker Manufacturer� ! � � K ��S Model Number q 1� X (. Size 31� Located At ►V1�.C�� ✓�p r� � 4L oa� 13 7 Serial Number 33�3 �. o � Is the assembly installed in accordance with manufacturer recommendations and/or local codes?`��3 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 `b�� psid Held at�psid Opened at� Opened at Held at initial Test Closed Tight� Closed Tight I�( psid psid psid Leakedl � Leaked�I Did not open I Did not open � Leaked� 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 W '1 K �� T b-S SN: � �-{ I 50 56 y Date Tested for Accuracy: Z- (i� �L Remarks: The above is certified to be true at the time of testing. Firm Name �/V�� d� I��t.vw�J ��"� Firm Address I I S �-(v �7 ��"`"° Q' � �a l �b"-S TX Certified Tester(pr�nt)j�H�3 C,�,•�w �'ertified Tester(signature) n{,r►-H�S [��-�t� w•--...,._�,�..� Firm Phone# Z 1e.�3� [ q 3 0� Cert.Tester No. �POo��.(3SS Date S 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 IRRIGATION DOMESTIC J 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) 1ZZ MAILING ADDRESS: I J J� C rw5 T 5 j �c. �f �o (��t l ( T�X CONTACT PERSON/PHONE: "1 1 2a LOCATION OF SERVICE: I 3� ? C r�sTSj�� (��a ��T <«7� 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 pl�educed Pressure Principle ' IReduced Pressure Principle-Detector : 1DoubleCheckValve '��IDouble Check-Detector � IPressurcVacuumBreaker I�"�Spill-ResistantPressureVacuumBreaker i� Manufacturer�v w�!7 Model Number � � Q Size � Located At �.J�T� � (,aie i �O3 Serial Number � �3 a 6 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? y�� 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 p ' �psid Held at `� � psid Opened at Z•� Opened at Held at Initial Test Closed TighY,� Closed Tight � psid psid psid Leakedl I Leaked.�I Did not open I '�� Did not open � �� Leaked'�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight''�. ; ClosedTightf 1 psid psid psid Test gauge used: Make/Model�,J l ( (�� N� ��7� SN: 6 L( � SO S(o y Date Tested for Accuracy: �— � g— �!Q Remarks: The above is certified to be true at the time of testing. FirmName �f �^� t'�'�` ��-�w�l+^C�� Firm Address ( � � y0 �� `'"'v �� 7 "` � « r � Certified Tester(pr�rir) (�LS Lu...v� w•uw,,(;<,�tified Tester(signature) ��w i5 �-a'^� ►'�-�r"'"- Firm Phone# L�4 3�I (�3 d`� Cert.Tester No. l�i 1�U � l��S Date �S^ t�' * 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 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: � �7 3 G�S T S� �C, 1� � �D T��'� �( T� CONTACT PERSON/PHONE: A"1 Z �-1 I �b Lo LOCATION OF SERVICE: I 3�� t fT�d t � r' Ca �'Pt ll 1'"�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 �educed Pressure Principle '� IReduced Pressure Principle-Detector � I Double Check Valve I 'Double Check-Detector ��PressurcVacuumBreaker i �Spill-Resistant Pressure Vacuum Breaker Manufacturer W 1 �K �^S Model Number �� f,._. Size 3�_ Located At I'�L,��r'n�_� �� b � Serial Number 2 I LI Z S� L� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? y`� 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 �•�isid Held at�psid Opened at�,� Opened at Held at Initial Test Closed Tight,� Closed Tight � p � p P . p Ps�� sid sid Leaked� I Leaked'��j Did not o en '� I Did not o en I I Leaked�� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight I 1 ClosedTight� I psid psid psid Test gauge used: Make/Model�(l(�C�r�S T�� SN: ��SJS6�( Date Tested for Accuracy: 2- �`�j-' �� Remarks: The above is certified to be true at the time of testing. Firm Name lf�i T� �w..n..� (�*-1 Firm Address ( � 7�� O � � �°`� �� ` NN^ Certified Tester(print) �r.i S I..,�w-�. �'^'�rtified Tester(signature) �-��i S L�"'� �"'t'"'�4v�� Firm Phone# 2��1 S �'1 (A 3 v v Cert.Tester No.B��v 0 l L(3 S� 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) MAILWG ADDRESS: 1�3� C n�S7Si �� 17r Co ��Gl 1 TX CONTACT PERSON/PHONE: C�—]2 LL'�� S b z.o LOCATION OF SERVICE: _��j�� pr (,�r'Pe.t 1 1' �' 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 ��°��Double Check-Detector IpressurcVacuumBreaker � Spill-Resistant Pressure Vacuum Breaker I Manufacturer l.�U�rT5 Model Number � 0 G� ►� Z Size � 2, Located At ��w� p ro,, r� � o-✓�"' S�� p,.Ts�al Number � y?i I 8 � Is the assembly installed in accardance with manufacturer recommendations and/or local codes? y �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 �'Zpsid Opened at��0 Opened at Held at Initial Test Closed Ti htl�l� Closed Ti ht psid p psid psid Leaked� I g Leaked I g � Did not o en f I Did not open Leaked' Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opcned at Held at Repair ClosedTight'� ClosedTightl I psid psid psid Test gauge used: Make/Model �,.i� 11�►�"�S T�J .S SN: C� Ll ( S� S ��I Date Tested for Accuracy: Z� �Y' �6 Remarks: The above is certified to be true at the time of testing. Firm Name Uv� i tt,�w.�c�,.,.•.�c.wt Firm Address � �S�-(0 ��t eti.�a �2,n ��. < <�`t T x ,�� Certified Tester(print)�,7, �,�.�t, �^�"L ertified Tester(signature) D�-"�� -a�z ►ti—�►....,,r,,, � Firm Phone# Z.�M'S �-I l q 30;� Cert.Tester No. a I��435.T Date �� - � 6 * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS White- Ciry Copy Yellow-Customer Copy Pink-Tester's Copy