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2016_0426 IRRIGATION DOMESTIC FIRELINE� T� 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: �I��- � ''��' '-'`' : ' - CONTACT PERSON/PHONE: 'c i��° =,�'i.-� ;� �� ' LOCATION OF SERVICE: `- � �µ �` �� ,< r-��' � 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 ' IReduced Pressure Principle �Reduced Pressure Principle-Detector ��ouble Check Valve -1 Double Check-Detector Pressure Vacuum Breaker '�Spill-Resistant Pressure Vacuum Breaker Manufacturer WA' Model Number,�ff�� /J /"' � Size � ' Located At � �� Serial Number �D �% � �� Is the assembly installed in accardance with manufacturer recommendarions 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 2,� sid Neld at�psid Opened at Opened at Held at I itial Test Closed Tighi�[� Closed Tight� psid psid psid �j4S� Leaked I Leakedl � Did not open 1 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 I I Closed Tight I psid psid psid � Test gauge used: Make/Model �� C�.1'V �� SN: U 7 O7��Qr/ Date Tested for Accuracy: '�" � � Remarks: The above is certified to be true at the time of testing�-,. , � n� l�l�� o-��, �iPOc� �S?f ,�3.�-�t- /��/ ��,�-� Firm Name �lM�r� Firm Addr ss l Certified Tester(print) �� 1� Certified Tester(signature) � Firm Phone# ��`��' � Cert.Tester No. �� _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 fortn 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: I✓t� 'L E�4 � CONTACT PERSON/PHONE: U►N i LOCATION OF SERVICE: - {L i2 � 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 ��:�1 Reduced Pressure Principle I �Reduced Pressure Principle-Detector I l�uble Check Valve ��l Double Check-Detector PressureVacuumBreaker Spill-Resistant Pressure Vacuum Breaker Manufacturer_ WPq'�T S Model Number ��7M1 �� Size__�_ . Located At ��2�� t� �(;� Serial Number �Of �� 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 � �Z psid Opened at Opened at Held at �itial Test Closed Tight�� Closed Tight� psid psid psid 1fk�i� Leakedl�1 Leaked.��l Did not open f 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 Closed Tight I � psid psid psid Test gauge used: Make/Model �d/�1�z�'` I '✓ � SN: �� D��f d� Date Tested for Accuracy: � '�g '�� Remarks: The above is certified to be true at the rime of testing. Firm Name ��Cy`��' ►"�� 1 R��`�`Firm Address ��S ?5 ��'� 11�"�2K �l�-l�� Certified Tester(prirr) �� aQ"'� Certified Tester(signature) �- � Firm Phone# Cy[��3 4� - a�,� Cert. Tester No.��0�� 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: � +'�1- CONTACT PERSON/PHONE: aN G� ,�r� - �/ . � LOCATION OF SERVICE: 615 f�r2 ee-top� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is cerrified to be operaring within acceptable parameters. TYPE OF ASSEMBLY Reduced Pressure Principle IReduced Pressure Principle-Detector �Double Check Valve �-� !Double Check-Detectar �� 1PressureVacuumBreaker �-��Spill-Resistant Pressure Vacuum Breaker Manufacturer ��I�5 f Model Number ��7 � 1 � Size � Located At �12l�N l �k -�k�2�� 1 /`� Serial Number �� 9 �a�/ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �-2f 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 Initial Test Closed Tight Closed Tight � psid psid psid � Leakedl ''� Leaked' 1 Did not open ; 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 . ClosedTight I i psid psid psid Test gauge used: Make/Model �� I ��-NI ��j SN: ��7,� � (9 7� Date Tested for Accuracy: '(—�U'��j� Remarks: The above is certified to be true at the time of testing. Firm Name �T►��iv / /QP �"'"I`��1�Firm Address ��S�5 V pb�� '7L�L ��`��S Certified Tester( r�nt) ��12�� Certified Tester si nature P � g ) Firm Phone# a��'3�C1� 2-2''2 � Cert.Tester No.V�"�� 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