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2016_0325 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: �jVt� 5• /�c.Ar}lwt` ��a�e�\\ , riw,s 750�°1 CONTACT PERSON/PHONE: Mw�a.u�c- , `/72- 3�13- �17 6 K LOCATiON OF SERVICE: �+va' C��na.k f�+�.�fnan�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 �1Reduced Pressure Principle I IReduced Pressure Principle-Detector �Double Check Valve I 'Double Check-Detector ` 1PressureVacuumBreaker CSpill-ResistantPressure Vacuum Breaker Manufacture��.� Model Number�� Size�� Located At � �e 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�psid Held at�psid Opened at Opened at Held at Initial Test Closed ighti�l'� Closed Tight � psid psid psid Leakedi I Leaked' I Did not open I 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 I �� psid psid psid Test gauge used: Make/Model�� `"�� SN:��O�Dc� Date Tested for Accuracy: �'��'�)� Remarks: The above is certified to be true at the time of testing. FirmName�� Q�� Firm Address'�(�,��[� �L- Certified Tester(pr�nt)�,� a e �'CCertified Tester(signature)�L(��_yi1,,� i� Firm Phone#�� 0 �1 Cert.Tester No.Oa�(pG.,C? Date Q L� � * 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: ��0� S. ��c c'��I` , eoPtK�l , ��- 75019 CONTACT PERSON/PHONE: J�(a c�— — 572- 393-�1,�4$ LOCATION OF SERVICE: R��c�'CI�wS� A,.d`�FmtnfS 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 -IReduced Pressure Principle-Detector vl'ISouble Check Valve I Double Check-Detector � IPressureVacuumBreaker ��-1Spill-Resistant Pressure Vacuum Breaker Manufacturer�,,Q�� Model Number ��I Size!,h� Located At��L� Serial Number 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 Tight 1 Closed Tight ��I psid psid psid Leakedl✓ Leakedl�,1/ Did not open ! Did not open I Leaked 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�u0'�-wlt-$�-- �'�,S SN: (�.��,3 Date Tested for Accuracy: ��1�—z��S Remarks: A ' ,�`-�D W -FU I�� The above is certified to be true at the time of testin�. Firm Name �� ,��Firm Address �,�Tl� � •� �� r Certified Tester(print)�!��1�J�'Wx�I��C.J�o� 6� Certified Tester(signature) �yL��(�/�� Firm Phone#�I`" 1 `'1'l�°�l Jp 0 U Cert.Tester No.A9�-�p��_Date V * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE ✓ The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) /� � MAILING ADDRESS: GvV s MGc�c��nc(' , L,pppG�� TGx1'✓.� —750\°� CONTACT PERSON/PHONE: M�,r�a�,ec- - �71- 3�i3- �{Z�$ LOCATION OF SERVICE:�'u��('('�nasc, f�raat�M�tn�'s 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 `�Reduced Pressure Principle 1Reduced Pressure Principle-Detectar :vY�oubleCheckValve ��1Double Check-Detector I IPressureVacuumBreaker I ISpill-Resistant Pressure Vacuum Breaker Manufacturer�.��CJ� Model Number �� Size � Z� /�l Z3 Located At �� Serial Number 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 Tight� Closed Tight 1'� psid psid psid Leaked'�. 1 Leaked�I Did not open ' � Did not open I 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�`'(�1��' '�� SN: �'��tn(p� Date Tested for Ac�uracy: �l��'�� Remarks: The above is certified to be true at the time of tesring. Firm Name��11,�Y1A7�'�fl(�-�rt��_Firm Address �/UQ� ��QX�,�Y��. Certified Tester(print)�y�QQ� �R�� Certified Tester(signature) Firm Phone#��_ �� Cert.Tester No.O�� Date �,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� 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) / C MAILING ADDRESS: l��U J _ /�c,c�r'�wl' � �� 75b1q CONTACT PERSON/PHONE: Me,w,erl i `l72� 3�13' 47G.g LOCATION OF SERVICE: ��w�Glnc.se. f4os,c-ttv�u��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 f��Reduced Pressure Principle-Detector - ouble Check Valve i Double Check-Detector I �PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer �.2�� Model Number �� Size�� Located At ��X��yV11 Serial Number�F��J 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 Tight� Closed Tight f psid psid psid Leakedl I Leaked� I Did not open I I Did not open I � Leakedi �� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�� I ClosedTight�� psid psid psid Test gauge used: Make/Model�r� vu�"�W �� SN: (��,� Date Tested for Accuracy: �'ZZ'Zb1� Remarks: The above is certifred to be true at the time of testing. Firm Name ��[�1JCA'TFirm A ddress�i'��. �Q��fL,L� Certified Tester(print)��/a,Q�'� Certified Tester(signature) � ��z� Firm Phone#v I�f —1�J JJO� Cert.Tester No.t�IQ��-�Date �� 7iS * 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 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: OO S. I�QC,A�f-�1u r `�P�CGS 750�� CONTACT PERSON/PHONE: ��na- er - q'I - 'y�3- Lg LOCATION OF SERVICE: � r rv��n 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 i 1Reduced Pressure Principle C�Reduced Pressure Principle-Detector i�:�Double Check Valve I� �Double Check-Detector ' PressureVacuumBreaker ' Spil1-Resistant Pressure Vacuum Breaker ,�j,� i Manufacturer ,��,`,� Model Numberl�"jtJS� Size�_ Located At � � Serial Number �� 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 H�ld at Initial Test Closed Tightl�' Closed Ti ht i 1 psid psid psid Leaked�Y Leake� Did not open I I Did not open f ' Leaked f I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight' ' ClosedTight 11 psid psid psid Test gauge used: Make/Model UVU��-IA��' a''�S� SN: ��$�� p�p� Date Tested for Accuracy: q'�Z2,`�� Remarks: �G�Q� `��t-C.� The above is certified to be true at the time of testing. Firm Name,K�ru�K'�SL.��Q� Firm Address 11t� � 4�Q��✓1��• Certified Tester(print) �'Ini ��Certified Tester(signature) Firm Phone# ��'��3'3��g Cert.Tester No.�jp((a �_Date 3 25 ?,�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Ye11ow-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) MAILINGADDRESS: (i . M��G ��lLl �5Q��7 CONTACT PERSON/PHONE: � �I� - - LOCATION OF SERVICE: \�I U, 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 '+�IDoubleCheckValve !Double Check-Detector ::�PressureVacuumBreaker :�Spill-Resistant Pressure Vacuum Breaker t Manufacturer �� Model Number �� Size � Located At I�-l;�.Q��C.�c�L� �� Seria] Number�� 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 Ti ht f�' psid psid psid Leakedl� Leaked� Did not open f 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 l�'�� psid psid psid � Test gauge used: Make/Model �.\(�-��$� Fj�S-� SN: Q'�'�5'�,(p�23 Date Tested for Accuracy: ��Z2-7�� Remarks: �Q.��CI� -��1,� The above is certified to be true at the time of testing. FirmName��Yl� '�U'�(.P. �Di�CJ�11t1Y I Firm Address��,TV�1��YQ��. Certified Tester(prinr) �/�,�� ( ��Certi$ed Tester(signature) Firm Phone# ��f� 1��4�� Cert.Tester No. 6@)(p(Q,2� Date �/� � �`-r * 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 LD. # 0570040 (Customer) MAiLiN� aDDREss: l.� . MG�- P�'R-t'hu,� ,p 4il � G� 1SDi� CONTACT PERSON/PHONE: �'1 " "13� 41� LOCATION OF SERVICE: \ The backflow prevention assembly detailed below has been tested and maintained as required by commission regularions and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY '��1Reduced Pressure Principle �� Reduced Pressure Principle-Detector ��oubleCheckValve '�Double Check-Detector I� �PressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker ��,,�" t Manufacturer �1� Model Number pU� �� Size � Located At �� 1�'X 1'�w� Serial Number�� l� 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 I psid psid psid Leakedl�l/ Leaked{,;. Did not open � Did not open '� � Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTightl�� ClosedTight I psid psid psid Test gauge used: Make/Model"1�� SN: (��Q�3 Date Tested for Accuracy: �� 1 Remarks: �7Q�� L11� The above is certified to be true at the time of testing. Firm Name �,1��(L� Yj,1��pLrU�Firm Address `��,��J• � �Q,��(: Certified Tester(pri�t)�,[� (JJ�OY�,� Certified Tester(signature) 7.� �� Firm Phone# ��`T�� V��O Cert.Tester No.�(Q�__Date n Iz� �� * 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 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) �/� � ' n MAILING ADDRESS: Uv S• I�u�-�-�1� �O � -CX ��SOI� CONTACT PERSON/PHONE: �I - LOCATION OF SERVICE: A 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 iReduced Pressure Principle f 1Reduced Pressure Principle-Detector ��ouble Check Valve I I Double Check-Detector �i� IPressureVacuumBreaker f �Spill-Resistant Pressure Vacuum Breaker Manufacturer ��i1[�('.� Model Number�✓� Size r� Located At /q �5?X�� Serial Number��-- 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 Tightf I Closed Tight �1 psid psid � psid Leakedi� Leakedk,,.l� Did not open i��I Did not open I I Leaked'� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTightl] ClosedTight ��I psid psid psid Test gauge used: Make/Model hM l�-� �"lJ"� SN: �`��(�p(p3 Date Tested for Accuracy: �'�,' '?A� Remarks: (�L14a�f�l� �G1� The above is certified to be true at the time of tesring. Firm Name I�►K��1LQ��(�l(c��Firm Address ��Y�S�Y 1��(�; Certified Tester(pr�nt)�,�('�QIQ �„�„C Certified Tester(signature) �/hA.�C ��1�� Firm Phone# ��I� �`'1"U��J uU Cert.Tester No.i`��(p�� Date � C �° * 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: �O� MUL � �TX 1 Q CONTACT PERSON/PHONE: � `� �' l.R LOCATION OF SERViCE: �� Sf. 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 IReduced Pressure Principle-Detector ��oubleCheckValve -7Double Check-Detector 1PressureVacuumBreaker f ISpill-ResistantPressure Vacuum Breaker Manufacturer�1� Model Number�� Size �� IZ Located At��7RJ1/ I�a'YY\ I � Serial Number��.p Is the assembly installed in accardance with manLifacturer 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 Tight�� Closed Tight I '� psid psid psid Leakedl�l/ Leaked.lJ/ 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 ClosedTightl�� ClosedTight'i�.I psid psid psid Test gauge used: Make/Model,r��A"��,q,?"�� SN:��0.� Date Teste{d�f,o,r Accuracy: —� Remarks: C�,�� -�Gl�� The above is certified to be true at the time of testing. FirmName ��YI•a�.��RQ��'1 Firm Address 1�,�� Z.�C'. Certified Tester(print) m_�� Certified Tester(signature) � Firm Phone#��l'��j��0�1� Cert.Tester No. (`b��_Date �J� u"W * 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 1� 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: � U I� �I�Q � CONTACT PERSON/PHONE: G � LOCATION OF SERVICE: ' u 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 �Reduced Pressure Principle-Detector ��ouble Check Valve -1 Double Check-Detectar 1PressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker Manufacturer��[`15 Model Number ��p Size�� Located At��P� � 7� Serial Number(}�0� 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 at psid Opened at Opened at Held at Initial Test Closed Tight'�,i Closed Tight C.' psid psid psid Leakedl� Leaked'� Did not open I ' Did not open I Leaked 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 ��Q,��S-� SN: d`��(p(Q3 Date Tested for Accuracy: ' Z'Z� Remarks: �C,�=-�C(,� '�1�� The above is certified to be true at the time of testing. Firm Name Q�n.M'I��YR� irm Address �,1��QU��(��, Certified Tester(print)��'Certified Tester(signature)��(/�t(��i�r✓� Firm Phone# l�1�'��1,��0 Cert.Tester No.hf��-� Date IJ�J 2J �� * 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: O S. MGGP'C��I(1y1'(� (�� CONTACT PERSON/PHONE: G1 `fi� " LOCATION OF SERVICE: A 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 C�Reduced Pressure Principle-Detector I :Double Check Valve � Double Check-Detector [ PressureVacuumBreaker i-;Spil1-Resistant Pressure Vacuum Breaker 1 Manufacturer�j,�,l`� Model Number . Size�� Located At�,SL�-�-� ��Z Serial Number�� 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 1 Closed Tight I psid psid psid Leaked� Leaked�' Did not open I Did not open i I Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight C Closed Tight:I psid psid psid Test gauge used: Make/Model �/,L`��' �'-�� SN: O�'�S(�tO3 Date Teste for Accuracy: �'?.Z' Remarks: �(,�OLI) l��'J The above is certified to be true at the time of tesring. Firm Name�Yla�ilY.¢ Firm Address ��,1�1-�' �•$�y�$��1V��r, Certified Tester(print)��C Certified Tester(signature)'��.��_�� Firm Phone#,/�I�f��'��^ �0 D 0 Cert.Tester No.�9��e�Datev� * 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) � p� � MAILING ADDRESS: lQQ�} I��'�'�'�1� G ��1 CONTACT PERSON/PHONE: C� �-1 —� " -- (Q LOCATION OF SERVICE: �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 � IReduced Pressure Principle 1�1Reduced Pressure Principle-Detector. ��1DoubleCheckValve f 1Double Check-Detector 1PressureVacuumBreaker ' iSpill-Resistant Pressure Vacuum Breaker Manufacturer��C'� Model Number �� Size2�/L Located At � '�' 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 InitialTest ClosedTightl�� Closed,,T/ight I1 psid psid psid Leaked*� Leakedl"1 Did not open '� I Did not open f '�� Leaked I I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTightl I ClosedTight _I psid psid psid Test gauge used: Make/Model� •�,Q �� SN: 1��(d(a� Date Tested for Accuracy:��S Remarks:�1��Ul� �U��$2� The above is certified to be true at the tirne of testing. FirmName��1Y1� �'�, Firm Address��1�y�i��QNQ��n.�,� Certified Tester(print)��„��SCertified Tester(signature)� Firm Phone# ��`'�� Cert.Tester No. pp�(Q(03.3 Date � �SI�`� * 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 Y 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 LD. # 0570040 (Customer) I' � MAILING ADDRESS: (o�� 5 •�Cx[ �f'fN�l� , CoPI�C�� /C� 7 �0�� CONTACTPERSON/PHONE: n �`- 72- � ' �'1 G LOCATION OF SERVICE: Q;v..r Gl�.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 iReduced Pressure Principle '7Reduced Pressure Principle-Detector �DoubleCheckValve i�Double Check-Detector ! IPressure VacuumBreaker I I Spill-Resistant Pressure Vacuum Breaker ,i• ,_,,^ � Manufacturer`'I,'JL�C:=I� Model Number_�� Size � Located At�,� Serial Number 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 Tigh� Closed Tight � psid psid psid Leakedf� �� Leakedl I Did not open [ Did not open ' ! Leakedi ' Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight 1 Closed Tight��'' psid psid psid i Test gauge used: Make/Model YV1�A4 Lt`�o fi(' ��-� SN:��(o(p�3 Date Tested far Accuracy: �''22"��s Remarks: The above is certified to be true at the time of testing. FirmName�+�'VI`Y�1L�S1�� Firm Address �� ,_�. Certified Tester(print) m��gg� �Q Certified Tester(signature) y� ��%(�JY�y� Firm Phone# -LR" I��" ��v v Cert.Tester No.�b'��,,._"Z�Date �"25`��° * 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: (�v� . /Hac c'� Co CI� TC S ��d� CONTACT PERSON/PHONE: M�rw�(— , 572 -39 ' ti7G8 LOCATION OF SERVICE: I�ivc�C�as� �Pu�}Mcm�'S The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is cerrified to be operating within acceptable parameters. TYPE OF ASSEMBLY ' Reduced Pressure Principle Reduced Pressure Principle-Detector �oubleCheckValve IDouble Check-Detector � IPressureVacuumBreaker -ISpill-ResistantPressure Vacuum Breaker Manufacturer�,t ,,� Model Number�f Size�_ Located At��Z� Serial Number��j� Is the assembly installed in accardance 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 l st Check 2nd Check Held at psid Held at psid Opened at Opened at Held at Inirial Test Closed Tight� Closed Tight I I psid psid psid Leake� Leaked.� 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 C7 ClosedTight' I psid psid psid Test gauge used: Make/Model��Jl-��Q;f� '�'�� SN: (�{�(0(0� Date Tested for Accuracy: ��A�� Remarks: �:��C�7 �UA�� The above is certified to be true at the time of testing. Firm Name ��u2 �rm Address� � ' �1-W�'Y�`��n,A�? � Certified Tester(pr;nt)m►� � I,� Certified Tester(signature)��<��J�l �� Firm Phone# 214"��3� �� Cert.TesterNo. t9'��(n�� Date �` 25� ��a * 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