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RPZ_2016_0613 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: I 30 (`a �� ` � CONTACT PERSON/PHONE: euui Z!y- ce o�fb LOCATION OF SERVICE: I B'S� (.�7, I�ci r/CG��y 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 -1K�educed Pressure Principle �� 1Reduced Pressure Principle-Detector i�IDoubleCheckValve � IDouble Check-Detector CPressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer UV GL-Ct'S Model Number �� 1 Size � ,' Located At_��ZZ Serial Number �9`f' �Z� Is the assembly installed in accardance with manufacturer recommendations and/or local codes? ��eS 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�� Z psid Held at psid Opened at 3�7 Opened at Held at Initial Test Closed Tight'�Q Closed Tight � 1 psid psid psid Leaked� I Leakedf I Did not open C�I Did not open _J Leaked.l 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�M�r''A_�U �� SN: Z-s�j�4� Date Tested for Accuracy: o — � � — ��S Remarks: 'The above is certified to be true at the rime of testing. /� �— I-t Firm Name `D��-�/ ..� g� Firm Address � W/�tM r!� Certified Tester(pr:nt) LJGt V 101 ��!�t//�1 Certified Tester(signature) � � Firm Phone# J-�'T- `T q 4-`C�� Cert.Tester No. IX��7�8 Date � �3 �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 N 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) ' \ n MAILING ADDRESS: l 3 O3 w+`o� ��' 1.,� � CONTACT PERSON/PHONE: L � — ZI —4 lP — O LOCATION OF SERVICE: l�S' l,t�. P 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 ❑Reduced Pressure Principle-Detector ��-IDoubleCheckValve ❑Double Check-Detector '�PressureVacuumBreaker CSpill-Resistant Pressure Vacuum Breaker Manufacturer uV0.�`�Cj Model Number 1 �I Size 3�T Located At �� e`ZZ �•�K, Serial Number (P Z��Q� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �eS 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��to psid Held at psid Opened at .Z Opened at Held at Initial Test Closed TighC�f Closed Tight f_� psid psid psid Leaked'� 1 Leaked�1 Did not open � '_ Did not open I l Leaked�� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight_� ClosedTight I` psid psid psid Test gauge used: Make/Model�flLv�,D RJ�LD "��`"�� L-SN: ZS gOb� Date Tested for Accuracy: L��g +�s Remarks: The above is certified to be true at the time of testing. � \ FirmName�,��I I L 5�_Firm Address I � V �►� Certified Tester(pr:nt) � �� Certified Tester(signature) � Firm Phone# �'�T � �`1 �v—��Q Cert.Tester No�C QQQ�Q�,�j� Date tP �� * 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 n 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) n /� MAILING ADDRESS: l� I 3 I1 I� ` ef/ CONTACT PERSON/PHONE: �W�`S '� O 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 �educed Pressure Principle CReduced Pressure Principle-Detector -1Double Check Valve f'Double Check-Detector �PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker ' \ a n Manufacturer UVf3l Model Number �0 1 m� Size 3�� Located At �+ �,eZ Z S` 1.1� Serial Number � S� 7 f� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? VeS 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,�T�'psid Opened at .Z Opened at Held at Initial Test Closed Tight�d Closed Tight C� psid psid psid Leakedl I Leakedl.; Did not open I�1 Did not open i 1 Leakedl � Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight LJ Closed Tight❑ psid psid psid Test gauge used: Make/Model ��'�-v �Q� �'��K SN: (o Z � �� Date Tested for Accuracy: �� Remarks: The above is certified to be true at the rime of testing. / � p� , 1 FirmName �Pr� �S(.� Firm Address �-303 W�U1 � �V: Certified Tester(pr:nt)�aV j� �,.,•�� pJq Certified Tester(signature) Firm Phone# ��7 ' T�� `� Cert.Tester No.�PDd DFl7S gj Date �v �Jr !� * 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) t � 1 MAILING ADDRESS: I �03 W i"G '� �✓� 2I1 CONTACT PERSON/PHONE: �.., �S 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 �iReduced Pressure Principle I 1Reduced Pressure Principle-Detector ❑DoubleCheckValve ❑Double Check-Detector C'PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer W 6 I/C I�✓ls Model Number ��s� Size�_ Located At �2-� �C'�'Z Serial Number �- ��7� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ;�e5 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 Z•� Opened at Held at Inirial Test Closed Tight 1 Closed Tight �.7 psid psid psid Leaked��-] LeakedC l Did not open f�'�� Did not open ��1 Leaked� 1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTightL� ClosedTightC�l psid psid psid Test gauge used: Make/Model ��'1'1 Dr'G-CC� �4'.ZQQ�SN: Z`�J d d�(� Date Tested far Accuracy: (v��/�S� Remarks: The above is certified to be true at the time of testing. � Firm Name �B�( I L S� Firm Address � � Cerrified Tester(print) � �� Certified Tester(signature) � Firm Phone# ��—�q(P —$�� Cert.Tester No. � �� Date � �.3 ��o * 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: ��0 3 �c`a ��t� `�' �p �(� 1� CONTACT PERSON/PHONE: i' CiCtS - 4 - O C� LOCATION OF SERVICE: I$5 L�� QrI,U,uO�.�I 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 C Double Check Valve �-�Double Check-Detector C'�PressureVacuumBreaker �lSpill-Resistant Pressure Vacuum Breaker (� n t� Manufacturer 0.�-}`,s Model Number "I � �1 Size � Located At ��G� �1re, 1-iS�r' �OOpv� Serial Number �q(p''l��o Is the assembly installed in accordance with manufacturer recommendations and/or local codes? t{�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 ?, Z psid Held at psid Opened at�J� Z Opened at Held at Initial Test Closed Tightfj� Closed Tight C] psid psid psid Leakedi I Leakedl J Did not open ❑ 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 f�� Closed Tight f l psid psid psid Test gauge used: Make/Model D �CO -- Zb�� SN: zS�j�Q� Date Tested for Accuracy: l J� ��7r Remarks: The above is certified to be true at the time of testing. Firm Nam�p(�e�' ..�- 5� Firm Address �J � 1 � R� , . Certified Tester(pr�nt)��S i��!>CA1 ��I Certified Tester(signature) Firm Phone# Z��- �7(��[��Cert.Tester No.V�� 7 Date �3 �b * 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) f1� MAILING ADDRESS: �3�3 �Tan ler �rir � .� ( � CONTACT PERSON/PHONE: �.��e1 �5 �Q 2� - SO O LOCATION OF SERVICE: l 5� � A1^ Ci�•r 0. 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 4�Reduced Pressure Principle ❑Reduced Pressure Principle-Detector �DoubleCheckValve �IDouble Check-Detector ��PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker �,I K � ' ,, Manufacturer i ►n 5 Model Number ��5��—� Size �'Z� Located At GOt1C�`��f�►� �t'e� Serial Number �`C�� p� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? e 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� psid Opened at �►� Opened at Held at InitialTest ClosedTightn ClosedTight CI psid psid psid Leaked�� Leaked�7 Did not open ❑ 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� psid psid psid Test gauge used: Make/Model � U l�"�� SN: ��r�00 O Date Tested far Accuracy: �' l,� Remarks: The above is certified to be true at the time of testing. , `� t �� FirmName �OpG�� 5� Firm Address �3�'� WPO� PI� (r Certified Tester(prpnt) 0� L• � Certified Tester(signature) � � Firm Phone# 2�`l� — '7 n"f�o r��7C� Cert.Tester No. (�� Date � �3 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 I.D. #0570040 (Customer) MAILING ADDRESS: O� � �r- CONTACT PERSON/PH NE: L.eW QC,�[,�S 7� — µ9 ' O 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 parameters. TYPE OF ASSEMBLY i�educed Pressure Principle f=lReduced Pressure Principle-Detector ��-I Double Check Valve ❑Double Check-Detector ��7PressureVacuumBreaker �Spill-ResistantPressure Vacuum Breaker � \ rq , ,� Manufacturer Wa S Model Number Lr�� 1 aT Size �� Located At ��"S�ar� Serial Number cp -I �0 1 3 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e5 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 ��Z psid Held at psid Opened at 3' � Opened at Held at Initial Test Closed Tight� Closed Tight ❑ psid psid psid Leakedf I LeakedC�� Did not open ❑ Did not open .] Leaked'.I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight'��7 Closed Tight'i I psid psid psid Test gauge used: Make/Model l�M�� Q� Z� �" SN: ZSS�� Date Tested for Accuracy: `I I�� S Remarks: The above is certified to be true at the time of testing. FirmName �/ ��• FirmAddress 7J��J W!`Glh E�✓��I�' Certified Tester(print) l/CJl U 1�L��I�� Certified Tester(signature) � � � Firm Phone# �1� ��—Od� Cert.Tester No. �QQ��p��J" Date � i3 � * 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) i 1 1 n n MAILING ADDRESS: f 303 l�lJ+'�0�✓L�'i le►' l�ir �-C�pf•�e��)C CONTACT PERSON/PHONE: �ew i 5 c�� ZI y- 4 t� -- o y�0 LOCATION OF SERVICE: $$ , rL�'wc� 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 f�2educed Pressure Principle ;�IReduced Pressure Principle-Detector [JDoubleCheckValve flDouble Check-Detectar ❑PressureVacuumBreaker �'Spill-Resistant Pressure Vacuum Breaker I �, Manufacturer G,,0.� Model Number �I� � �I � � Size �7� Located At �1k�� m(�ihe �0'��^' Serial Number__�f S b Z Is the assembly installed in accordance with manufacturer recommendations andlor local codes? �e 5 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 ��1.� psid Held at psid Opened at 3f`� Opened at Held at Initial Test Closed Tight�i Closed Tight ❑ psid psid psid Leaked�l Leaked� I Did not open ��1 Did not open ❑ Leaked I�1 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 Test gauge used: Make/Model 'T�-��T�C SN: �-S 8�� Date Tested for Accuracy: �� Remarks: The above is certified to be true at the rime of testing. Firm Name�D��,�� =s� Firm Address ��Q3 W �' ` Certified Tester(print) lJ � � �� Certified Tester(signature) -1' Firm Phone# �� — T�� Q rv Cert.Tester No. �� 5 Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS � �i3 J �(o **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: 303 W i eII � CONTACT PERSON/PHONE: 'S 'a 2��f- �f —g0�O LOCATION OF SERVICE: l�S C�� Ctr y 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 7Reduced Pressure Principle-Detector 7DoubleCheckValve i 'Double Check-Detector �PressureVacuumBreaker f-Spi11-Resistant Pressure Vacuum Breaker Manufacturer �/l�a'1'ts Model Number �-F��1 QT Size �/Z. Located At Ki-f-u.�F,Y� L f,E �p��1�. N�'f�'� Serial Number � f �ZS Is the assembly installed in accordance with manufacturer recommendations and/or local codes? YtS 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 ��s psid Held at psid Opened at��Z Opened at Held at Initial Test Closed Tight'�t'� Closed Tight f�� psid psid psid Leaked I Leaked..I 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 Closed Tight L 1 Closed Tight-] psid psid psid Test gauge used: Make/Model �D�'�^��-o �Q w.Z�f�- � SN: Z SSbC)O Date Tested for Accuracy: ��o �S Remarks: The above is certified to be true at the time of testing. Firm Name�D�� L S � Firm Address �3�3 WI^Ol(10� ��' �/�� 1 f Certified Tester(print) �'P� Certified Tester(signature) Firm Phone# ��`t"`t�t�o`"�j�'f"D Cert.TesterNo.V��b�S�Date L `� �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