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2016_0325 (2) IRRIGATION DOMESTIC FIRELINE� The following farm 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: 9N S ,_�'� �Cw� ��ir�i l eX�►S 7 d�9 CONTACT PERSON/PHONE: 7 - 9 - 7 LOCATION OF SERVICE: Rive �nr,.Gc, firlel��FS 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 CReduced Pressure Principle-Detector oubleCheckValve �=:Double Check-Detector [ PressureVacuumBreaker i Spill-Resistant Pressure Vacuum Breaker Manufacturer Y��`� Model Number 7"YJ\ �( Size 1 'Z Located At�9..�� Serial Numbe i�—�� 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 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� 1 psid psid psid Leaked� Leaked� 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 Closed Tight I 1 Closed Tight �1 psid psid psid Test gauge used: Make/Model �� $`�S SN:�(_p3 Date Tested for Accuracy: 1' Remarks: The above is certified to be true at the time of testing. Firm Name � Address 1��. �Gtj,(t7q��,� Certified Tester(print)�`�� j�_Certified Tester(signature) Firm Phone# ��' `1�3^ �� Cert.Tester No.OO��p�Q� Date 3-`LS'�� * 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: GU� S , /1�lGC��-Fhvr ,�'opnc,l� TX� 75019 CONTACT PERSON/PHONE:/Kc.rao,e� - 9�' 3 3 �11G8 LOCATION OF SERVICE: �:�c� „�c�5t �Pw�tKQc►�� 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 I IReduced Pressure Principle-Detector iihl5ouble Check Valve I-'Double Check-Detector I IPressureVacuumBreaker ' I �Spill-Resistant Pressure Vacuum Breaker Manufacturer�,,p/�(� Model Number �� Size '�_ Located At 2� �� 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 V alve ]st Check 2nd Check Held at psid Held at psid Opened at Opened at Held at Initial Test Closed Tightl � Closed Tight I I psid psid psid Leaked'�✓ Leakedv� Did not open i I Did not open ' Leaked'� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opencd at Held at Repair ClosedTight-.l ClosedTight l 1 psid psid psid Test gauge used: Make/Model ��il�� -� SN:��,s 1�¢ Date Tested for Accuracy: �"Z��L Remarks: 1�(��ll� `�� The above is certified to be true at the time of testing. Firm Name I�►'H r w�'1�tiQ�(6��S�,�j�1 Firm Address �� J. ��,�� Certified Tester(prf nt) ��C/h0�1� �b1(l$' Certified Tester(signature)� ��•,��F/— Firm Phone# L 1�T"'0�'�~ �Z�� Cert.Tester No.�(Q(Q� Date 3�2 5' �L * 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 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) / ,�l MAILING ADDRESS: /9 �V S , /�G.�e.�r'�r►u�r , Oe..11 Tt�S ��61� CONTACT PERSON/PHONE: I�,,nc,�U` - c►72 -�13• y?G�i LOCATION OF SERVICE: (.��ou-C'�,.5rc. �esc�rlt�n-Fs 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 7Reduced Pressure Principle-Detector i�Double Check Valve l Double Check-Detector f�,�PressureVacuumBreaker �:�Spill-Resistant Pressure Vacuum Breaker Manufacturer�� 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 Tight.1 Closed Tight ��1 psid psid psid Leaked� Leakedf 1 Did not open 1 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 ClosedTight[ ClosedTight C. psid psid psid Test gauge used: Make/Model �'I/�f�-{I�1�c,z$�" 8-"1�� SN:D_��Q3 Date Teste for Accuracy: 'Z�'�� Remarks: ��-�UW -�t.1� The above is certified to be true at the time of testing. FirmName'R.�11,�r�.'p�r(V��O�'�C��aYlFirm Address��f`i•�i,r10�R�n�2_�'� Certified Tester(print)��,Q��,��S' Certified Tester(signature) Firm Phone# ��4 � L�v3 3 0� D Cert.Tester No. (bL(Q433 Date �-2-5 �� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White- Ciry Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE�� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MaiLiN� a��REss: (� s , �l�r�'1�,,�- , f I T��.- ��1� CONTACT PERSON/PHONE: Mc.r e.r - y72' 3' LOCATION OF SERVICE: '(.�;vai�C�t /�pc,� L�-Es The backflow prevenrion assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ! I Reduced Pressure Principle I Reduced Pressure Principle-Detector M'bouble Check Valve I��Double Check-Detector CI Pressure Vacuum Breaker C Spill-Resistant Pressure Vacuum Breaker � Manufacturer�� Model Number Size� Located At��tj Serial Number �� Is the assembly installed in accardance with manufacturer recommendations and/ar local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve l st Check 2nd Check Held at_ psid Held at psid Opened at Opened at Held at InirialTest ClosedTight�l ClosedTight '�1 psid psid psid Leaked�� Leakedl�1 Did not open � I Did not open I�' Leaked'�� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight- 1 Closed Tight I psid psid psid Test gauge used:Make/Model Y1/�l!'��.$-t'��S-$� SN: ��S��V3 Date Tested for Accuracy: � 2.'� Remarks: ��(�Ul� -F!/l I� The above is certified to be true at the time of testing. Firm Name '��,G1�1,�'�Y_�)�_�Firm Address )`(Y� �•S��p,�('� .QC. Certified Tester(pr�nt) ��Certified Tester(signature) Firm Phone# ��J� �� Cert.Tester No.�),�e fp�,�Date 3"Z S� �� * 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 LD. # 0570040 (Customer) MAILING ADDRESS: f�� S , /��t�c,(�c��p,�P ,� Cuwc�e\\ �tu..s 7�j 6\q CONTACT PERSON/PHONE: M,wr.o,�d' - �- 3`� -i1'1.f.& LOCATION OF SERVICE: ��t� a c�rn�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 iReduced Pressure Principle -lReduced Pressure Principle-Detector �oubleCheckValve -1Double Check-Detector �IPressureVacuumBreaker ��lSpill-Resistant Pressure Vacuum Breaker Manufacturer �Q�;(� Model Number �Y Size�� Located At ��¢N �,b6 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 Initial Test Closed Tight� Closed Tight I 1 psid psid psid Leakedik LeakedG� Did not open ��1 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 1 Closed Tight f: psid psid psid Test gauge used: Make/Mode1��C��`� ��'�j� SN: 01��p� Date Tested or Accuracy: � -Zt�l Remarks: ��w�.�X l� -�U,l� The above is certified to be true at the time of tesring. 1��nn'��.,��.e�v�r. Firm Name" ,�- Firm Address 1,�� .��`Y,p ,�. Certified Tester(print) ��'�11�,��Y 13Cerrified Tester(signature) Firm Phone# �� IG�—��j Cert.Tester No.flpl(v(a 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) CONTACT PERSON/PHON� S M��' �� '-' 7�CQ� ��)� LOCATION OF SERVICE: �\�ItiQ,� 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 ]Reduced Pressure Principle �Reduced Pressure Principle-Detector ��oubleCheckValve �1Double Check-Detector 'PressurcVacuumBreaker Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number`�� Size�� Located At �.�c�Drv�, Serial Number 1�� Is the assembly install in accordance with manufacturer recommendarions and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Ch �k Valve Assembly Relief Valve Air Inlet Check Valve ]st Check 2nd Check Held at�psid Held at �i°�psid Opened at Opened at Held at ' Initial Test Closed Tigh�f�?' Closed Tight � psid psid psid Leaked��I Leakedl�I Did not open I 1 Did not open � I . L'eaked��. 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 ��'��("�� SN: d��Q�_ � Date Tested for Accuracy: `"22�� Remarks: The above is certified to be true at the time of testing. Firm Name�lu�Vl��.Q.��Firm Address `�,b`1 (�- �,11�� Q,_Q('. Certified Tester(print)��,��A�1(Q,�rtified Tester(signature) ��A}�� Firm Phone# G��" l�� Cert.Tester No.�l�Q,_((j�3 Date �".�.5" �� * 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 COPP LL PWS I.D. # 0570040 (Customer) S• GC�PcR-��lS� C6� � �°� MAILING ADDRESS: T CONTACT PERSON/PHONE: ' � � LOCATION OF SERVICE:�\�L�IC�(10. A'�. The backflow prevenrion 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 i:lReduced Pressure Principle ❑Reduced Pressure Principle-Detector i i�Plouble Check Valve �1 Double Check-Detector GPressureVacuumBreaker �iSpill-Resistant Pressure Vacuum Breaker Manufacturer�� Model Number t�\j�QC Size�� Located At V �� 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 2nc1 Check Held at psid Held at psid Opened at Opened at Held at Initial Test Closed Tight' '� Closed Ti t I ' psid psid psid Leakedf✓ Leaked Did not open I I Did not open `'� Leaked�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight'i 1 Closed Tight[] psid psid psid Test gauge used: Make/Model 1/�1C�'�SL��' ��-� SN: C��S�(o(v3 Date Tested for Accuracy: '7�2.� Remarks: �Gl�C11� 'FLU� The above is certified to be true at the time of testing. �, � 1�'� �F �'1�.�('T��Y�' �. Firm Name �VI,(7 �LY,� Firm Address �. p ,� Certified Tester(print)�� , ertified Tester(signature)�UI,�"('/�� Firm Phone# h �4" `1�3— ?j�$�5� Cert.Tester No.(��(Q�Q��_Date 3 "2 5- (�' * 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) MAILINGADDRESS: ��• MGGPG��Y1�l�L ; CQ Q, "r (A CONTACT PERSON/PHONE:M0.C1U � � 3 � - LOCATION OF SERVICE: IZi� 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 I�Souble Check Valve '� Double Check-Detectar I PressureVacuumBreaker ��Spill-ResistantPressure Vacuum Breaker Manufacturer �.�bC:C� Model Number ��Q Size �� Located At Serial Number�� Is the assembly ins alled 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 Opencd at Held at Initial Test Closed Tightid� Closed Tight � psid psid psid Leakedl I Leakedl ' Did not open ( I Did not open � I Leakedl 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 ��,�QS} ��J-� SN: �`�_(Q(�3 Date Tested for Accuracy: �'�,-�� Remarks: The above is certified to be true at the time of testing. FirmName �a��"Q�_Firm Address,��_¢�. �',�1�.j��', R Certified Tester(pr�nt)��Certified Tester(signature) �_ Firm Phone# z��'-�3 -3�� Cert.Tester No.@��I�1�22 Date� '�►5' �� * 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