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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: .� U� �. � sT h ;ah o �� (�Z CONTACT PERSON/PHONE: r/ a LOCATION OF SERVICE: " � �/ � i�1�.� � � S'W Fre-c��!-� /�� The backflow prevention assembly detailed below has been tested and maintained as required by commission reguladons and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY I Reduced Pressure Principle 1 Reduced Pressure Principle-Detector ��,B�6ubleCheckValve �!Double Check-Detector � iPressurc Vacuum Breaker � Spill-Resistant Pressure Vacuum Breaker Manufacturer!j(�a�Ts Model Number�� Q� Size /0 ,� Located At /�. S+G�- � �ja� �y �'d� Serial Number ��fl.�� is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi ]e 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 G� psid psid psid Leaked I Leakedl Did not open 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/�� i�JS '��T'� sN: D��.�3 0 3�0 Date Tested for Accuracy: `%�///� Remarks: The above is certified to be true at the time of testing. Firm Name}�Gt�- ,�y j�yYlS >�'hG • Firm Address_ �.�� /C�9�h�� /'�in�i?L✓!�Ti�. 7��f Certified Tester(print)�� r'��j Certified Tester(signature � D��'1 G�-�- Firm Phone��/7� l9�� ^2 Z2� Cert.Tester No.�P041S.�� Date ,3 d��/ * 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 FIRELWE � 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 1.D. #0570040 (Customer) / MAILING ADDRESS: j u�l.� cc��`f�G �� F �l��S'ndiunctnc��S��Jy �6:2?� CONTACT PERSON/PHONE: ri s' a(�c�S LOCATION OF SERVICE: '��eci.ur ,��z,�c tJ v �'r{.�. o�,� J�w�_ 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�i-Plouble Check Valve ��1 Double Check-Detectar I iPressureVacuumBreaker 1Spill-ResistantPressureVacuumBreaker Manufacturer�a-�S Model Number a0� �'y1� �T Size -3 '�� Located At �. Srp�e.- � ��J �y �dL Serial Number �Z L3��o� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? G r7 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 ��.2_psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight 1 Closed Tight f � psid psid psid Leakedl Leaked �I Did not open I ! Did not open '�� ' Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight i Closed Tight� I psid psid psid Test gauge used: Make/Model�i��+ nS ��l ' ,j SN: f� � �3,j0,3 ti Date Tested for Accuracy: 7l>�!S Remarks: The above is certified to be true at the time of testing. FirmName�RL �9/S��S�Ln � Firm Address 7�� /��h��rli/1�6�1 i�• �� .� Certified Tester(prFnt)��1 ��G� S Certified Tester(signature) �� Firm Phone#�/7� L`�a'ZZZ�Cert.TesterNo.gl�d��-��5� Date 3/v��li� * 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 I.D. # 0570040 (Customer) \ MAILINGADDRESS: l��c./�C.C. �e�al�� /G �� 9GST1n��k��opo�� ,Z�• � b2�O CONTACT PERSON/PHONE: �i a LOCATION OF SERVICE: �, ,�n�'�i n e r �✓' � �'C. � ��'L� �r��-�or'f �J� 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 i Reduced Pressure Principle :I Reduced Pressure Principle-Detector ��ouble Check Valve � I Double Check-Detectar ' PressurcVacuumBreaker . Spill-Resistant Pressure Vacuum Breaker Manufacturer L.(�u�'_S Model Number �D 7�J� L�'T' Size 2 � � Located At /��. ��.G D1' � �`�� ✓`� ��'�"�-�-"� Serial Number /pZ S�`�� 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�i�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight'�� Closed Tight� 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 1 ClosedTight I psid psid psid Test gauge used: Make/Model !�i��h�s ��" � SN: ��e / 3 3 d 3 d Date Tested for Accuracy: 7� /�/� Remarks: The above is certified to be true at the time of testing. Firm Name�Ot G — s �/STC�'!S�1h G Firm Address 7S� /� `��ST/��1�?�'� ' ��" � � 01 J Certified T'ester(print)��n ��,/'G� q Certified Tester(signature) �'1 J�[ L� Firm Phone#l�l 7�f��d "Z 2.2 3 Cert.Tester No.BPl90l.�3sl Date�3�a�� 6 * 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: k�� Q�� o � `'�" o�' a � r • 1�[�Z�b CONTACT PERSON/PHONE: �%S� !/V al r5 LOCATION OF SERVICE: a% Lr i`�� r ,C�c�.� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable paraineters. TYPE OF ASSEMBLY ' Reduced Pressure Principle 'Reduced Pressure Principle-Detector �T�louble Check Valve ]Double Check-Detector �� IPressurc VacuumBreaker � �ISpill-Resistant Pressure Vacuum Breaker Manufacturer �Et�� Model Number pp7 �/ �' Size 2 � � Located At x�� S�� o� ��f• �� S�^�� Serial Number /a �0 03 / Is the assembly installed in accordance with manufacturer recommendations and/or local codes? .r-� 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 ato�-�psid Opened at Opened at Held at Initial Test Closed Tight lv Closed Tight '� psid psid psid Leaked� �� Leakedl� '� 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 ClosedTightl � ClosedTight�� I psid psid psid Test gauge used: Make/Model ��1�� r1 S TG '.� sN: o G�3 3 0 3� Date Tested for Accuracy: ��/ �/� Remarks: The above is certified to be true at the time of testing. FirmName �4G �!/S'T��S ��'�G • Firm Address %u�/ �a9�h ��`��9 I"`� i�' �6�� Certified Tester(print)��i�1 �,c�r'�'G/ �j Certified Tester(signature) �"��? ✓�"`�"" Firm Phone#��/7�� a 'Z Z 2 3 Cert Tester NoBP��S3S/ Date 3�1�,�� * 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) ` MAILING ADDRESS: U�,�c�� l�er1��,1 ��nd C. 9� ST��ianal�o/iS�'/�• �rv�b CONTACT PERSON/PHONE:/!�iriSY�d 1 a� T LOCATION OF SERVICE:�h�urn��z �Sav �'rt�� k�,�•� • 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 1 Reduced Pressure Principle-Detector i�Bouble Check Valve �I Double Check-Detector IPressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker Manufacturer�iI�aTI-S Model Number Da 7 �/ GrT Size Z � � Located At�- SiG�2 �� I�9 �y ST/1C¢��' Serial Number /9'�J o� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? 1/GS 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 a�. r psid Opened at Opened at Held at Initial Test Closed Tightl/Y Closed Tight � psid psid psid Leaked��1 Leaked I I Did not open (�I Did not open �� I Leaked � Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opcned at Held at Repair ClosedTightl�� ClosedTight'��i psid psid psid Testgaugeused: Make/Model�it�• /k/nS ��'-� SN: 0�2��3 � �� Date Tested for Accuracy: � J/�� Remarks: The above is certified to be true at the time of testing. FirmName�a_�S`��S�Lit�- � Firm Address�s/ /Og��-��/'�• �- ��° �� Certified Tester(print)��1� �j�r`�� Certified Tester(signature) � �� Firm Phone#�,frl�� i��"Z 2 Z3 Cert.Tester No.1�0015�1 Date ��Z�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 FIRELINE V 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) MAILINGADDRESS: �,��ea�� "�jb� ,�. 9� s�''7'v�G1�%CZMGiAo�iS ,L/�� 7G2� CONTACT PERSON/PHONE: � � S LOCATION OF SERVICE: �° ai n�/' S rf ��6� �i�Gc-A� �wY' 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-Detector ��ouble Check Valve ��Double Check-Detector '�Pressurc V acuum Breaker Spill-Resistant Pressure Vacuum Breaker Manufacturer ��-S Model Number OG7 I'!'�/ LQT Size �/� i� Located At /�(�• Sidf, r�� c� i✓1 /J+ �� Serial Number S.�la � � 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 Tnlet Check Valve 1 st Check 2nd Check Held ata�2 psid Held at,2• (v psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight 4� psid psid psid Leaked'� � Leakedl I Did not open �� Did not open � Leaked��. Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight��J ClosedTight l psid psid psid Test gauge used: Make/Model��K�'nS T�-,S sN: �L� 3 3 a 3 � Date Tested for Accuracy: � < /l�� Remarks: The above is certified to be true at the time of testing. FirmName�aL �y��'��5 A� � FirmAddress7S� �/79��, /�r/r�/I�� ,ix� 7� °�/ Certified Tester(print)��N ��Gi -�'j Certified Tester(signature) /" �L Firm Phone��/�� `T D ZZz3 Cert.Tester No.,�iPO�/5.�� Date ,31•?.��/� * 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 M 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) MAILING ADDRESS: �� 0 s��' i� o v �' N• � CONTACT PERSON/PHONE: �i GUa( rS LOCATION OF SERVICE: ut� a%ne S� �< ,S c� � C �r^f � 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 ��1Reduced Pressure Principle-Detector �uble Check Valve '�Double Check-Detector IPressurcVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker Manufacturer%�Gt"�S Model Number�J7�y��/.�� Size � ,� Located At �i(�• �+� d� �� rn �i� Serial Number JOQ5�7/�ooZ is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Asseinbl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at�� psid Held at3�� psid Opened at Opened at Held at Initial Test Closed Tight�1� Closed Tight Iv psid psid psid Leakedl � Leaked I Did not open I 1 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 I ' Closed Tight� I psid psid psid Test gauge used: Make/Model fi(l� ��'Si nS �� r,� SN: ��o/�,30,3t� Date Tested for Accuracy: 7l/�� Remarks: The above is certified to be true at the time of testing. FirmName �i�L ��ST�mS , i� G Firm Address �-�� Gr'/' h �� ,��i✓I9'7�n,��7G�� Certified Tester(print)�f�� r�i/ �' Cerrified Tester(signature 4�� Firm Phone#��, �/`7�rD�o�3 Cert.Tester No.,�Da!S3S/ 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 IRRIGATIONJ� 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: e.a � �00 sT i ah o �Ii � �2�-' CONTACT PERSON/PHONE: �iS• e l LOCATION OF SERVICE: • a�rt�r • r�c U � t-c v� 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 �ouble Check Valve � !Double Check-Detectar I Pressurc Vacuum Breaker 1 Spi11-Resistant Pressure Vacuum Breaker Manufacturer 1/1,a�5 Model Number DO y Y/9/ Q"T Size 2 � � Located At /�l, SiU� o� ��'9 �7� S'T�f Serial Number 19'7.3,�� 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 at2.Z psid Opened at Opened at Held at lnitial Test Closed Tight� Closed Tight� psid psid psid Leaked ' Leaked l ' Did not open 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 Closed Tight i �� psid psid psid Test gauge used: Make/Model Uv��i�I� ��'� sN: d�/33�.3v Date Tested for Accuracy: �� Remarks: The above is certifred to be true at the time of testing. Firm Name�RG Sy S��e+�'!S T'n G • Firm Address?S�I �0!��/-�r�r✓►9�✓��• 7G �� r " Certified Tester(print)��h ��r C��' Certified Tester(signature) � �`— Firm Phone#'��l�7)��0'ZLZ3 Cert.Tester No.,BPO�/.S^��/ Date�<Z��/� * 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