The URL can be used to link to this page

2016_0428 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 1�,�1ME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) �� MAILING ADDRESS: �tKc' �°/9 CONTACT PERSON/PHONE: porv �w � LOCATION OF SERVICE: �lGa r�V�c � , ot� 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 i�ouble Check Valve -�'Double Check-Detector '� IPressurcVacuumBreaker � �Spill-ResistantPressureVacuumBreaker Dd ✓h 1 ,� `� Manufacturer ��4-�� Model Number 7 Size Located At �Gxi �'� �Y '�'�� ► "�`� ��C�erial Number ,�� Is the assembly installed in accordance with manufacturer recommendations andlor 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 �ittal Test Closed Tight� Closed Tight � psid psid psid f1-�f Leakedl � �� Leaked 1 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 I Closed Tight �1 psid psid psid ',�,/ � l �r Test gauge used: Make/Model vVY/ �►� ��J SN: �/5��-��"✓ Date Tested for Accuracy: '7" �� /Z,� Remarks: The above is certified to be true at the time of testing. Firm Name��-' �� -�"`� Finn Address �� l� ��"` ��''��` 1✓�� Certified Tester(print) �"�� /��'�w'�� Certified Tester(signature) ��'`'7 Firm Phone# `��l 3�� ✓ �Z� � Cert.Tester No.�'��16 0� Date �`�g`f *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) f� MAILING ADDRESS: IJ Vl � �� CONTACT PERSON/PHONE: t�� C LOCATION OF SERVICE: -e.e✓ 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 ouble Check Valve �� Double Check-Detector IPressurcVacuumBreaker I �Spill-ResistantPressure Vacuum Breaker Manufacturer Model Number �V 7/�� Size� Located At �i�.l�-�/�� G(�0`t/ I Serial Number � � 7 Is the assembly installed in accordance with manufac urer 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 Ini 1 Test Closed Tighti�( Closed Tight\Ij psid psid psid ��S Leaked' I �� Leaked. 1 �` 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 7 Closed Tight��I psid psid psid Test gauge used: Make/Model U��'l�'��' I (�v/ SN: ��v�� .�'/ Date Tested for Accuracy: N'�S�� Remarks: The above is certified to be true at the time of te ting. � , F�rmName �Y`�'P►�GWoi �� -+il"- ir�in Address 7l/ �V,f� �� Certified Tester(pr�nt) � Q,r� �` � �Certified Tester(signature) �J �� / Firm Phone# �� T"�� Cert.Tester No.D��f Date ��`�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 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: {��t- K� �� !� J CONTACT PERSON/PHONE: D►v .� � LOCATION OF SERVICE: r -� � 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 I Reduced Pressure Principle-Detector '�ouble Check Valve i Double Check-Detector I ressurcVacuumBreaker I �Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number O 7�I GZ1 Size � �_�i �y� r � Located At ►C7L��' � ��U' ' �w �l'E u Serial Number ��Z 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�'O psid Held at Z Z psid Opened at Opened at Held at Initial Test Closed Tighti� Closed Tight� psid psid psid ��S� Leaked 1 Leakedl�I Did not open �1 Did not open i � Leakedl 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 W!'/�C`� / �� SN: O�d�� Date Tested for Accuracy: �-i' I�� Remarks: The above is certified to be true at the time o tes�ng. � �� y � - � ,� r►n2�P1�� /Ipv ��Ql ��YFirm �ddress l �1 7,5 !/< S �+t �� Firm Name � Certified Tester(pr�rir) �Gt,N��-� ��Z��ertified Tester(signature) Firm Phone# � 1�'�/`�".z�� Cert.TesterNo� ��1� U / 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 or�g�nal 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: G� � �+4 CONTACT PERSON/PHONE: O.v LOCATION OF SERVICE: � � 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 '�Double Check Valve �uble Check-Detector I �PressurcVacuumBreaker ��Spill-Resistant Pressure Vacuum Breaker Manufacturer � �-� Model Number `�7 y Size �� Located At ��'C�'� b't� ��u�r � �(/l�erial Number � Is the assembly installed in accordance with manufacturer recommendations an 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 lnitial Test Closed Tight;� Closed Tight � psid psid psid Leaked.�1 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 Closed Tight I�l Closed Tight� I psid psid psid Test gauge used: Make/Model �e l K�r' I V J SN: (/�' d � 2 ��v Date Tested for Accuracy: �-��S''�V Remarks: � The above is certified to be true at the time of te ring. w►z��►�+,t, F �/'�1�eC . / ( I/! � �j-i2.�L-- Firm Name ry �� rm Address l �1 f !� t�� Certified Tester(prprt) ��+� 1��Certified Tester(signature) �� / . Firm Phone# �� "�� Cert Tester N�. � � � 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