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2016_0516 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) � ''y MAILING ADDRESS:��ts�-S�. o � ��'�,o,/�u, 6 7� S J—i�taaa�r� r��,. CONTACT PERSON/PHONE: —� y LOCATION OF SERVICE: 7� .S 1'r'.t.t p�. � 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 parameters. TYPE OF ASSEMBLY I IReduced Pressure Principle �R�ed ced Pressure Principle-Detector �� I Double Check Valve I�ouble Check-Detector -�PressureVacuumBreaker ['Spill-Resistant Pressure Vacuum Breaker Manufacturer _� � � �� ..� Model Number ��v k�1� Size �� r-��c,�n.�- Located At�s`�,� I� 1,a�s} c� 1- ��c�S Serial Number �-/(g (a O v 7 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 Tnlet Check Valve 1 st Check 2nd Check Held at � psid Held at � psid Opened at Opened�at Held at Initial Test Closed Ti t 1 Closed Tight �I psid psid psid � Leaked�, Leaked.'l� Did not open '� Did not open . I Leaked� '� Repairs/ G� �.. ed G1 ��4 Materials L Used Q"` � �`" r Held a�fL psid Held at�psid Test After Opened at Opened at Held at Repair ClosedTight� Closed Tight � psid psid psid Test gauge used: Make/Model ��`1'7 Y(/�G1�{% SN: ��p�� Date Tested for Accuracy: � —� � ��..� Remarks: - The above is certified to be true at the time of testing. � FirmName T`�"'�U't'1�� "�� Firm Address �� '✓�'�`�1R�1�`�-1 �� Certified Tester(print)��`n��Certified Tester(signature) L Firm Phone# ��$�� Cert. TesterNo. ��`�4 Date ��1 � '��i * 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) r MAILING ADDRESS: ��.d�f w o�l- �✓�¢.r.c� (41O "S ��cc�a� �' ��c....Y CONTACT PERSON/PHONE: LOCATION OF SERVICE: b7� � �r«aur� I c�,ti 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 1 ��Reduced Pressure Principle 1R�ed ced Pressure Principle-Detector I '�Double Check Valve �ouble Check-Detector ��PressureVacuumBreaker -;Spi11-Resistant Pressure Vacuum Breaker � Manufacturer �, � � �••.s Model Ny�mber 3>> �S* I�A► Size� ��-. �-��.. Located At �G�w� L�f � d �1��S Serial Number ..S��''!� /3 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 l st Check 2nd Check Held at�6 psid Held at�•psid Opened at Opened at Held at initialTest ClosedTight � ClosedTight � psid psid psid Leakedl I Leaked�.1 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�� Closed Tight� I psid psid psid �`/,,�;J Test gauge used: Make/Model �5 It'�"l`�e SN: ��/� Date Tested for Accuracy: 6��o - 1:� Remarks: The above is certified to be true at the time of testing. FirmName y-C17��A�(.� ��'1�`I� Firm Address �� 3�"� y"�`�a�� j�X��3 � : �e� -�� Certified Tester(pr.nt) �ll�ert�fied Tester(signature) �.... ��o � � 1or�.,,J�� Firm Phone# ��`T�- a�(�� I / � Cert.Tester No. 5� Date S"� b ''� � * 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 V 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: ��q��S�► o � /'tit.� � (O"�� -S' H/'c.,P�I��,..�� CONTACT PERSON/PHONE: LOCATION OF SERVICE: ��O S rr«��} 1 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 �JReduced Pressure Principle IR�e ced Pressure Principle-Detector �� '�Double Check Valve I�ouble Check-Detector �PressureVacuumBreaker I Spill-Resistant Pressure Vacuum Breaker Manufacturer W �I IG,�r•ti{ Model Number 3 S� /'T ST�/� Size g Located At�Uu� T � L.� e�t�he,� ,��i��. Serial Number 2��71� Is the assembly installed in accardance 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 atZ Zpsid Held at�psid Opened at Opened at Held at Inirial Test Closed Tight� Closed Tight f-'� psid psid psid Leaked I Leaked'�. 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 ClosedTight I I ClosedTight� I psid psid psid Test gauge used: Make/Model �tLl�j ��"l�% SN: C� � I I�a�? � Date Tested far Accuracy: (7- 1 � -/ �� Remarks: The above is certified to be true at the time of testing. 7�'�� 1'J� ��1 ��Vl��hvi�� 751�i� FirmName ��` [��%��f� Firm Address Certified Tester(prErt)�� `�-��ertified Tester(signature) ��-� � � ..,(�� Firm Phone# ��`��_Cert.Tester No. �� Date �—� 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 farm 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:�L•c.,��,. iCl � /`�'/�t��tq ��O -S �=/`e�ea��cw•' CONTACT PERSON/PHONE: LOCATION OF SERVICE: �j 7� ,�' �-=/'�t P.1�•+ ILw 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 I �Reduced Pressure Principle [Reduced Pressure Principle-Detector [��DoubleCheckValve I�ble Check-Detector ! IPressure VacuumBreaker �-I Spill-Resistant Pressure Vacuum Breaker Manufacturer �� l 11G��j Model Number 9's�� l� Size �`� Located AtvO►�►��/��c�rv,cv fl/'o►�e✓�—f Serial Number�g 7 (� c� 1 "2,. Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �tt Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at7�psid Held at3�Zpsid Opened at Opened at Held at Inirial Test Closed Tight�-�h� Closed Tight -�1� psid psid psid Leaked' I Leaked'.1 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 ClosedTightl I ClosedTighti I psid psid psid Test gauge used: Make/Model I,U'fT�� ( `� SN: �� O I d Date Tested for Accuracy: (9—1� -1 r Remarks: The above is certified to be true at the time of tesring. Firm Name��y��'�l�-�� Firm A ddress �� 3�(��-'� ��'l��1�V�l�f� /%� � �� Certified Tester(pr:nt)��Tb�.��Certified Tester(signature)_�a,�� D 1p�•.•�� Firm Phone# ��—�Q�"�`�1�� Cert.Tester No.�5�+ 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