The URL can be used to link to this page

2016_0608 C�iECK ONE: IRRIGATION DOMESTIC FIRELINE BACI�'LOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:L��S: i��T.S°�,�✓F /�'��-��r, �'a�/�-'f GG-,�r The bacl�low preveation assembly detaile� below has beea tested 3nd maintain� � nq�� bv TNRCC re_Quladons aad is certified to be operating within ac�eptable paramcters. TYPE OF ASSEMBLY C Raiucad Press�re Principle �' Pressure Vacu�Breaker � Doublc Check Valve o Atmosphere Vacuum Breaker Manufact�er ,��.�TTS Siu � �i Model Iv�ber �f� �'f G/ �'' Located At �-�i��f; G'!��/��1/s .� Serial Nimmber `��/ � �� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER Doubie Check v alve Assembly lst Cherk 2nd Checl: Relief Valve Air Inlet Check Valve Inival Test DC-Closed Closed Ti;ht o Opened at Opeaed at �sid Ti�ht ❑ Leal:ed ❑ nsid Ii� psid R.P-,_psid I,�;� p Did aot Opea o Leai:ed � �P� and Mataials Used Test After DGClosed Closed Tight a Optaed at Opmed at nsid Repair Tight ❑ vsid osid RP sid The above is certified to be true. Firm Name Z/��brl c6,�c,r.��/1 c�,�i sirc��Cadfied Tester �•4/�l,t� /111�.�L�s.4// Firm Address /,�ca s� c F.�;�K.4� �r;�w�Cert. Tater No.��C�.%�3�/l Date � •� �IC.�'////vf'y�. Ti�' � °j`3� Gauge # _�Si�l% c>QC�7 llate last accuracy tested � � ,� White - Customer's Copy Yellow - City Copy Pink-Tester's Copy C�IECK ONE: IR.RIGATION DOMESTIC FIRELINE BACI�7.OW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAI�OF PWS: CITY OF COPPELL PWS I.D. # LOCATION OF SERVICE:l/��.� �r /�f-G'!G%/?� �� G+C��-L�;�� 7,�0�� The bacl►�low prevmtion asscmbly detailed below has beea tested aad maintain� � nq� bv TNRCC reguladons and is cercified to be operating within acceptable parameters. TYPE OF ASSEMHLY e Reduced Pressure Principle �'� Pressure Vacu�Brealcer � Double Check Valve � Atmosphere Vacuum Breal:er �►�/i Maaufactiaer /�� Siu Modei Number �6L��1- C=�1� Located At .4.��G Serial Nimmber C2��.�� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R Doubie Check v alve Assembly lst Check 2nd Chec1► Relief Valve Air Inlet Checic Valve Ininal Test DGClosed Closed Ti�ht o Opeaed at Opeaed at _1�sid Ti�t o Lcal:ed o �sid osid RP-_psid �� ❑ Did not Open o Leal►ed � �P� and Materials Used Test AR,er DC•Closed Closed Tight o Opened at Opeaed at nsid Rcpair Tight ❑ �sid osid RP sid The above is cctifiod to be true. Firm Name �i4�11�Ir'I Ga�,e��i2c'��G �i�C��Certified Testa ��/%� /�� 'fZ. �� Firm Address f�D� � cF�T� E � •,� Cat Testa No.��'c�l��f Date � �� f�-1 cl�/r//1'�fi �;- (Gauge # (�' �/L��CS�'�7 llate last accuracy tested�iZ� White - Customer's Copy Yellow - City 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 LD. # 0570040 (Customer) MAiLING ADDRESS: /b��v; .G"��•T��F_ ,� �3cso Crv�j✓tz� , •�, 7Sd/l CONTACT PERSON/PHONE: ,lf�,Ql�r'! bS'f 7-,Z O�7/;Z� LOCATION OF SERVICE:2D7SS ` f-C�f�� /PJ'�,. -��n �'t�i"�_ 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 ' 1Reduced Pressure Principle ❑Reduced Pressure Principle-Detector ❑ ouble Check Valve n Double Check-Detectar ressureVacuumBreaker '1Spi11-Resistant Pressure Vacuum Breaker � Manufacturer G-�/.%'f .s Model Number �(S�7(`}�/ Size 3�� l Located At��`f�/f(�� 1�-G1�-/rr l'�o�.�,Q.S Serial Number��7�� Is the assembly installed in accordance with manufacturer recommendations and/ar local codes? S' Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check V alve 1 st Check 2nd Check Held at psid Held at psid Opened at Opened at :�i l Held at�� Initial Test Closed Tightf i Closed Tight f�''� psid psid psid Leakedf 1 Leaked I Did not open f�1 Did not open ��' �i Leakedi . Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight L] ClosedTight i 1 psid psid psid Test gauge used: Make/Model CrJlLj,C�/I S %c�- 5— SN: ��Qf'�f �� Date Tested for Accuracy: (�,Z�iCS- Remarks: The above is certified to be true at the time of testing. Firm NameL�}�Or�'J�o.ru.cdL/dCl.4G S�i�S Firm Address�� S,G�,��-L ��i��3� �u.rltr�li7t-�i Tx-r Certified Tester(pri nt)��l�j%��l��ertified Tester(signature) � � � Firm Phone# 9��-��f-��',��' Cert.Tester No.,�p��f6 3�/� 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 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: / ��,;�3�-L•T��/l�-�i� =��L��, ;�� "7 �ijl� CONTACT PERSON/PHONE: v��f�j.�/�J �/•?-2.n��^�,�:Z.� LOCATION OF SERVICE:�,/5�'� S� ��L•T/_i�f� 1g� x`'��n cn,��,�, � � '��: The backflow prevenrion assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable pa�ameters. TYPE OF ASSEMBLY i:]Reduced Pressure Principle �Reduced Pressure Principle-Detector �-_l oubleCheckValve I '�Double Check-Detector ressureVacuumBreaker f�Spill-Resistant Pressure Vacuum Breaker J �j�� -(�'i��T size � - �i Manufacturer �� Model Number Located At��jtJf� j��'i�L/�/�l G�6nL_��d�' Serial Number (�� Is the assembly installed in accordance with manufacturer recommendarions and/or local codes? l��S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air lnlet Check Valve 1 st Check 2nd Check Held at psid Held at psid Opened at Opened at Held at�� Initial Test Closed Tightl I Closed Tight I I psid psid psid Leakedf I Leakedf I Did not open '�� Did not open I�J Leakedl 1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight 7 ClosedTight[_i psid psid psid Test gauge used: Make/Model (��/G/.Cli'!S `%�t —.� SN:[°)��L�"1`�'�� Date Tested for Accuracy: ��j�''�%>� Remarks: The above is certified to be true at the time of testing. S��f� Firm Namel,�cc�T�/I �o.�,�[�i@C'i/�L Firm Address /�C�O .si Gk'�lT�_�°� ui;. '��l�o �tc-lc��1�'1f}�i -�-�. Certified Tester(print) ��(//i� /1��Certified Tester(signature) ��-�- Firm Phone#�'7.x�-��f�-�2�'2 Q Cert.Tester No��t��( 3`z'! Date C� * 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 LD. # 0570040 (Customer) MAILING ADDRESS: /��:�f t3�t-�!i/!f �,�i�r� Gn��. i.'r�_ 7.3'olg CONTACT PERSON/PHONE: �f " LOCATION OF SERVICE: lr�7j ;9,- i3y��:1�.7� �.D� 6C� �.�.� fL� ��= , 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 7Reduced Pressure Principle-Detector CI ubleCheckValve ��Double Check-Detectar ressure Vacuum Breaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer /�� ' S' Model Number �/�-�� L C�i•r Size 3 '`� Located At �j�Otl� Li��l�/�? GvoGf'-�� Serial Number C'�d,2r.� � Is the assembly installed in accardance 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�2.-� Inirial Test Closed Tight��= Closed Tight I i psid psid psid Leaked f 1 Leaked'. I Did not open Cl 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��_1 Closed Tight f l psid psid psid Test gauge used:Make/Model G'!�/!�<l/�S l c�—� SN: ��'�pD g �? Date Tested for Accuracy: �/.�-�'�S Remarks: The above is certified to be true at the time of testing. Firm NameG/�-�r�) G'D�r,1€•2ci�L Sv�'s Firm Address �,�L� S'� ��i?y�'1AG �-��J�i '��p ��%te�l/!t�fi'r T�': Certified Tester(print) �,4��f�/1�p�l�f'/Certified Tester(signature) � Firm Phone# �'7;�-`�%/�2�f�- �2.��Z� Cert.TesterNo.l3��(��,�/ 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 assemb 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: �/Q7� G�'�1jf��l�tf��P �3nn �vvF��G�. '��(p 7.��/9 CONTACT PERSON/PHONE: �S.�l�/1 ?�'!�-��y�9 LOCATION OF SERVICE: ��?,� ,�, �'�Tf��lf�i"7,�l�r��-�G� "��.- 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 iReduced Pressure Principle �Reduced Pressure Principle-Detector '�-7DoubleCheckValve �Double Check-Detector �ressureVacuumBreaker ��Spill-Resistant Pressure Vacuum Breaker Manufacturer / Model Number �( �fs��S �/�� ,%�� Size---�� . Located At�,��s� [��y�� C,.��s_'/s'_S Serial Number ,3�� ' 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 psid Held at psid Opened at Opened at� Held at�i� Initial Test Closed Tight��1 Closed Tight -1 psid psid psid Leaked'' I Leakedl.� Did not open I 1 Did not open f` Leaked'� ' Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight[7 ClosedTight� l psid psid psid Test gauge used: Make/Model /�//L1,li�s � ��-�� SN: D h��' O� 67 Date Tested for Accuracy: 6 /s�`�/%'�� Remarks: The above is certified to be true at the rime of testing. GS Firm Name ��L�'! e�.��1�/d_G'i,��j�lrm Address lo�D � , G f � c�G ��r��_�3efo �t�'l��i7�7f-�'. 'T1C Certified Tester(print)17,4U�.!��7�i�l��Certified Tester(signature) � Firm Phone# �'�,Z��,2�/-7 pz y' Cert.Tester No. ,f3'�QOf 6 3�! Date ��i�/�. * 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 LD. # 0570040 (Customer) MAILING ADDRESS: ,ll�i,j .��f-�GT/�f: �, �f� .�n��=l�TJ�C'� .7.��C� CONTACT PERSON/PHONE:,Sl�/1 �l�2i 8 5'— Z�l�� LOCATION OF SERVICE: ��2� ,�'� �f��r��/�� -�9�� '-�/��. 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 1Reduced Pressure Principle-Detector f=:Double Check Valve �Double Check-Detector f 'PressureVacuumBreaker :7Spi11-Resistant Pressure Vacuum Breaker Manufacturer�,� Model Number ��ize ��/ Located At�i�,Gf/�G,� //1�5 Serial Number �y�� 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 psid Held at psid Opened at Opened at 2C� Held at zs� Initial Test Closed Tight� Closed Tight I ' psid psid psid Leakedf�I Leaked�� I Did not open C�'�� Did not open �� 1 Leakedl Repairs/ Materials Used � Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight-1 Closed Tight I I psid psid psid Test gauge used: Make/Model Ll�fL%�`%/J S' ��r.� SN: Dy��/�� r�`� Date Tested for Accuracy: .�a .2-f�� Remarks: The above is certified to be true at the time of testing. ��GS, a� Firm Name f.A-��1 �'�,r�,t�t11��,�/_ Firm Address /�p� S� G�.r��' ��i� �o d�c c•�;��fy , �T�'c� Certified Tester(print) l�i4�l i� �G/6�i�j� Certified Tester(signature) � Firm Phone#�J�i�"��/.z Pz �' Cert.Tester No.l�l��/� 3�l/ 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 assemb 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 LD. # 0570040 (Customer) MAILING ADDRESS: /�)7�,f; /3f=Li��1-J f , '�3�� G��f.��i�, 75?�/�' CONTACT PERSON/PHONE: ��-��l-vy� $/��-z.c�, �y��J LOCATION OF SERVICE: 1 d ��5 �';�3£��T�� .��, �n��G,��-,. 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 [:lReduced Pressure Principle-Detector : I�ouble Check Valve CDouble Check-Detector y,�ressureVacuumBreaker I ISpill-Resistant Pressure Vacuum Breaker Manufacturer ��'�� Model Number ��'�� Size� Located At !�/X�,S,y��-�,r��,S Serial Number �� 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 at psid Opened at Opened at�� Held at ; � Initial Test Closed Tight�� Closed Tight I '� psid psid psid Leakedf 1 Leaked��. I Did not open �1 Did not open f � Leakedl �� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight I Closed Tight C psid psid psid Test gauge used: Make/Model G�lG/��yjS 'Til -� SN: � �D�d�' �"� Date Tested for Accuracy: .�,��Z��.� Remarks: The above is certified to be true at the time of testing. FirmNamel-..4�iJ:��l Co,�,��/�'[�i��S��F�m Address i�d 1� -�. �F/1'� L � a�,. 3�c� /-� �=t�C/il�'!�� 'T.�'� —� Certified Tester(print)��,¢�///,��Q/�''�Certified Tester(signature) -r Firm Phone# �7•Z- `11;Z �/'-iZ�,Z�Cert.Tester No�p��j,�j�� 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 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 LD. # 0570040 (Customer) MAILING ADDRESS: //��,�,� a�.�TG/�l� �� 3� l"�f�F.GL ,�_ 7.�f1 y' CONTACT PERSON/PHONE: �/�i�l,�J� �'� 7�� g��7 y';Z.� LOCATION OF SERVICE: !b� 3 S, " f G��j�j t� ��n r, r�D�,� GG . �� 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 ��-1DoubleCheckValve ��Double Check-Detector �PressureVacuumBreaker I�Spill-Resistant Pressure Vacuum Breaker Manufacturer GfJ,�T$� Model Number�� ,�� Size � Located At tcl,�4-S%�/,v�� ,��,f,�S Serial Number l0 7�!7� 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 at psid Opened at Opened at -� Held at .2��- Initial Test Closed Tightf 1 Closed Tight � I psid psid psid Leaked� I Leakedf' Didnotopen ..� Didnotopen I I Leaked��l Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight f��; Closed Tight CI psid psid psid Test gauge used:Make/Model C�f�/�S�/1�%l�'.� SN: f5 �''�� '� Date Tested for Accuracy: � �Z� <%� Remarks: The above is certified to be true at the time of testing. f�,��s, �� FirmName//¢lJ��? C'o�yrt�/��i�G Firm Address !'✓OD :S. �F��7�.i/_ ��l�f��Q �r ��.�%/1�°E-� i�, Certified Tester(print)�l�1� /-��1��! ertified Tester(signature) e ,�— Firm Phone# ��.�–�,Z�-2��;�� 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 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: � �b7S,;� ,Z�--LtL%/df/�7, ��L�'�P��TS �✓��19 CONTACT PERSON/PHONE: �iYj�c.Jo1 �/_,� -z0.� � 7`/'�� LOCATION OF SERVICE: �7✓'' ��,�y.��Li,�F' /2.D ��o �o%'i��G, T` , 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 CiReduced Pressure Principle ��lReduced Pressure Principle-Detector I JDoubleCheckValve �Double Check-Detector �essureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number �� y Q%Size��!l Located At ��,��[�/Jj� ��[�l/Jf-S Serial Number /��Y�� 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 psid Held at psid Opened at Opened at�,, 3 Held at� Initial Test Closed Tight� 1 Closed Tight '=1 psid psid psid Leaked� 1 Leakedf�!� Did not open _l 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 ClosedTight-1 ClosedTight❑ psid psid psid Test gauge used: Make/Model�i)fLjC//I,�'i� —5 SN: [��U�C�Q �`� Date Tested for Accuracy: � �.Z-,��l.� Remarks: The above is certified to be true at the rime of testing. Su'�5'� FirmName�i�l,�l��,st�/�c��FirmAddress/�o� �i ��1�/�r��- ��c�i�30o d�tG�i.�✓.�F y-� 'Ti�' Certified Tester(print)�,41%li� �'�t�/��i�r/ Certified Tester(signature)�_�, .�� Firm Phone# �7.z`l�.Z�-.Z �'�- � Cert.Tester No.�i°a�� 3� 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 far each assembly tested. A signed and dated original must be submitted to the public water supplier far recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: �/��Z��S,:,��L/'Li�'/�' �r�, ��ix� GU��t—LL , 'T�, 7.�G�j�' CONTACT PERSON/PHONE:�5;�./%,� $'�7— 2�.��- ��Q LOCATION OF SERVICE: i�,7��si l��C_�/,�f� c�, ~�'3�C� cO��LLj�,—X � 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 C�:Reduced Pressure Principle ' 1Reduced Pressure Principle-Detectar �-i Double Check Valve -7 Double Check-Detector �ressureVacuumBreaker -1Spi11-Resistant Pressure Vacuum Breaker � '/ Manufacturer�iC, � Model Number��/'j/S�'�l Q:Size�� Located At��,3L�f01 ��<<i�I G�NG�� Serial Number�� Is the assembly installed in accardance 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 Tight.� Closed Tight �` I psid psid psid Leakedf '� Leaked'i I Did not open '��1 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 ClosedTightC7 ClosedTight =1 psid psid psid Test gauge used:Make/Model G�f�%Cji�S '�� —_� SN:D�-/�� i' 6 � Date Tested for Accuracy: 6 l�Z��/��' Remarks:l �,t�/��- /11�7'— �UG�i�'i�;, �/�%! ��/��' i�cC�� C1��'/�" //� L i S� ✓��f� �d��'7�_; �.�>�S ��Si�e� L�S� ��s The above is certified to be true at the rime of testing. �/tl�S. Firm Name Li¢uJia,v! �'o�/�{�1L��¢1 Firm Address / - _ �� L � ; -�7��, G�"�rl��y,. `�. Certified Tester(print)�i�//�dUld�,r�y�Certified Tester(signature) Firm Phone#,g 7�Z.l��%f��>_ �' Cert.Tester No.l��lJDf�?y/ 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 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't��i'.�$�i3��Zi��: /Z,i7 �.>o v ��r��E�G�j�(, ��r' CONTACT PERSON/PHONE: 5��/�J/� $/'7-,Z U,� 7 y;2� LOCATION OF SERVICE: /D7� �S� /�f-�'�Gi�� Q,s7, �ion �'O� -GG 'T�- 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 C�Reduced Pressure Principle _�]Reduced Pressure Principle-Detectar G�Double Check Valve -1 Double Check-Detector ❑PressureVacuumBreaker -1Spi11-Resistant Pressure Vacuum Breaker i Manufacturer /!�i'�� Model Number �QC� ��l�' C,� '� Size 3 � � Located At �DU�`� ��j�� nn�s�S Serial Number ��J'�i� 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 Tight I Closed Tight 1 psid psid psid Leaked�.i Leakedl I Did not open '�1 Did not open I I Leakedl� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�] Closed Tight .-1 psid psid psid Test gauge used: Make/Model J�(�/�%��ii?s ��-J SN: �j�� d ? Date Tested for Accuracy: �l�y �l,� Remarks: /,��Gf� /I o! .�G�C�'��'c7� IZI�/1 �i��.f�iil_� !'t�i��- G�f�� /`9 ,�'S ,.��.lr�r �,��r'f/'T�rJ�> •,�'� �s�.�"j� G.��i .1,��2 The above is certified to be true at the time of testing. 3Ylfi FirmName �.,¢��d! C�u�.��.�-ir�� Firm Address ��j'Uc� Si "Gs'��;/��..�� '�J�i ��"� �t!i.1//1��/-. �x� � Certified Tester(print)�`��,¢�ili7,�i'�1��/��ertified Tester(signature) � .�i Firm Phone#��,,2--��J--'/-�9z 't Cert.Tester No.G�i�l_h�fE.��!/ 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 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: ,�'f�: �s��t .�, ��o L"�i�'-�.i�c. �7.�Ljjp CONTACTPERSON/PHONE: S/��}!� �j1-�;•-75',zy LOCATION OF SERVICE: ��5, i3�`;�'.�rc� �'D: ��n� Gur��'>�, �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 �lReduced Pressure Principle-Detector -I Double Check Valve ' 1 Double Check-Detector �ressureVacuumBreaker -1Spil1-Resistant Pressure Vacuum Breaker � r� Manufacturer �✓/,�-T��S Model Number G�,�QG �T Size___�� Located At,�'iG�Uf' icJ�L�c"//� �'[��C��.�' Serial Number (��i�-?�� 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 at psid Opened at Opened at Held at Initial Test Closed Tight.� Closed Tight C� psid psid psid Leakedf''� Leaked'�:l Did not open C� Did not open � I Leaked'�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�7 ClosedTight I psid psid psid Test gauge used: Make/Model /�J��l�/'�S' j�--.5— SN: (;��'7 Date Tested for Accuracy: ��02.�/!S� Remarks:!�P G�l�f /l�� /_o c,+q-�i--r,O . �CC�'J �Tf�T�,3GP E7C�/fG.. r�'lf c� ��/ i''TS' 9"��t�- i G//Z/_�% C�J/r� j�Si�� !��/f�/r/� The above is certified to be true at the time of testing. �l��S. Firm Name�/�IViD,r� ��Gr-T��2e�.��Firm Address /��Ot'� $. C� .iZ�� xiii� t/ �3nc� � G%<`i/1!'l j � '� "T�X', Certified Tester(print) ��fL1�l�i�1�JCertified Tester(signature) - Firm Phone#��",Z��;-,��/�,2 j�2� Cert.Tester No. ��p/h 3 yl 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 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: �C%7`J cJ�, 1�-G�TGli�1 �,��,• �3Ci��r3��'f LG,7�C', 7s�� CONTACT PERSON/PHONE: �l� rZ0 = LOCATION OF SERVICE: i d��_S� ��U�li'�1E; � G�P�f GC_ ?�' 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 C'Reduced Pressure Principle -]Reduced Pressure Principle-Detector i Double Check Valve -1 Double Check-Detector �'ressureVacuumBreaker -1Spi11-Resistant Pressure Vacuum Breaker Manufacturer �.(�/�'�/�� Model Number �-��S"�� i Size�� Located At�'��1� GiJ l�,l��/� G��)l�".@,S Serial Number Q,��,s� 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 Initial Test Closed Tightf 1 Closed Tight I I psid psid psid Leaked'�� I Leaked�l Did not open ❑ Did not open I � Leakedf�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight l Closed Tight C' psid psid psid Test gauge used: Make/Model Lv/�/<%�'!S '�[��"� SN: ��Q�'��'�'� Date Tested for Accuracy: �'/,,Z�' / %S� Remarks: ,l�Ei�'�Gf /�f�T� Gv t�Tfi� , /� O� �Y��r� '�. � 7i��_ C�r'�� //1 /��"�C%f_; �'L/�!7" GrJ�S '7�F�/"E_� G�Si +�/f s�/� . The above is certified to be true at the time of testing. ��Gf= FirmName��i��lr�`J ��F��/�C rlrm Address��C�U �'�� C��j/c�� €X��t.�� '�3��1 �G.%4��y- - _� Certified Tester(print)��'(�/;(��Q�Certified Tester(signature) �� Firm Phone#��iZ�,.11%—2-��Z� Cert.Tester No.��GC�f��{/ 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 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 LD. # 0570040 (Customer) MaiLiN�a��REss: f��.s'� �.��?i�'f� ��c� �c�l��'��1.?>�� CONTACT PERSON/PHONE:�',��,eytvi? .�f7�2 O�_ �y�.Y LOCATION OF SERVICE: iD-7f',S'i ,r3��iGi/1��. 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�1 ouble Check Valve C��Double Check-Detector ressureVacuumBreaker flSpill-Resistant Pressure Vacuum Breaker Manufacturer /�J�'�S Model Number �/�D'0,�,loG Gy'�Size___,5��.l�/ �� Located At A-'aDG/� lC�.�-%�-�e'J r po�+�/�-S Serial Number ��Z,��"- Is the assembly installed in accardance with manufacturer recommendations and/or local codes? J 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 Tightl ', Closed Tight I I psid psid psid Leakedl I Leaked��.�I Did not open f 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 /,�r'�<�!�S ��—�' SN: � �/U!'O r�,Z_ Date Tested for Accuracy: ��„�� Remarks: ��i/!G E- /1DY .G�e�jr�'r� , �d/J •��"S�s�/3G� � �C�� /-/�L/l f/1 / '/'rS' �G,%f . ��i/ G��/}S '%f�/�� f/-T�f�/z, The above is certified to be true at the time of tesring. f`l�Gs' FirmName�.A�?'vi'! G'd��l�2�/NL Firm Address �,,�� "�,/!T/��L �X�U..�t/ �C/�///i��l/ �, / Certified Tester(pri nt) / i�!/!%� � p�e f�'/�Certified Tester(signature) Firm Phone# ��,,2 y"�Z�.—,��-� Cert.Tester No.�/�'G�al�,��_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