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2016_0224 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 LD. #0570040 (Customer) MAILING ADDRESS: �O� �12f'SCQ��—�— CONTACT PERSON/PHONE: � LOCATION OF SERVICE: O r' �-�4C'�'j r�—��- 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 parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle C'Reduced Pressure Principle-Detector �bleCheckValve ❑Double Check-Detector CPressureVacuumBreaker :lSpill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number �� Size� Located At �{��^-�-- �� Serial Number��"G� ( �� 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 Tig ti_ Closed Tight - psid psid psid Leakedl�I LeakedC�l Did not open n Did not open ,� Leaked�-1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight C� psid psid psid Test gauge used:Make/Model ��(�-� SN: 31� � � Date Tested for Accuracy: ��l,� Remarks: The above is certified to be true at the time of testing. � Firm Name��'V��(2-W �.1'Ln, Firm Address � � �(�1��-'V � ✓� ��-G ,w9 � ! 7-U � Certified Tester(print)�,Y� �iQti��121� Certified Tester(signature) Firm Phone# �7� ��v 7 ,3�1� Cert.Tester No.'l ��'��S�� Date �Z�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 GANDARA IRRIGATIQI� INC. 3901 Clifton Dr. Richardson TX 75082 Office: 972-671-3776 Fax: 972-664-99 58 Cell: 972�67-3918 Email: eddiegan1@sbcglobal.net �� PRESCOTT LN BELMONT LANDING COPPELL TX To Whom it May Concern; An irrigation system was installed at the property described above. In accordance with the city of Coppell inspection requirements, we are providing the following information. This irrigation systemhas been installedin accordance with all applicable State and local taws,ordinances,rules,regulations and orders. I have tested the system and determined that it has been installed according to the irrigation plan and is properly adjusted for the most efficient application of vvater at this time. 1 year warranty from the day of installation. Sincerely p� �.�Xq EDWARD GANDARA ,�� ..••••••••. s ' '•• � .ti Z°""�� • �..»�'P~ �4'i�.•••.�'°°'GPN�PR i .." �,Ip�R�•••''� : �p�� ._�,��3q •eQ, '•P l��;•.......•�P@.�U FNED �