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RPZ_2016_0608 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) .�p� MAILING ADDRESS: �U��,(3FG�C/sIE (�f�✓r'oPi��Lc;- �r,�c ��f� CONTACT PERSON/PHONE:�'�� Zor�i�� LOCATION OF SERVICE:��_� ��,��F �� , ��c 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 1DoubleCheckValve ' IDouble Check-Detector �7PressureVacuumBreaker �ISpill-Resistant Pressure Vacuum Breaker ii Manufacturer (� � '/_� Model Number ��P,�1 �'Z� Size_� Located At �/r�G.� /!2 �r,.��,� 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 �f� Held at,��psid Held at�psid Opened at 'Zi Opened at Held at Initial Test Closed Tight�il,' Closed Tight� psid psid psid 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 ClosedTight'�7 ClosedTight'�-=1 psid psid psid Test gauge used: Make/Model /,�Jf�./�i�'I S �7� �'✓� SN: O�fs��? Date Tested for Accuracy: vl�,Z,Q�/� Remarks: The above is certified to be true at the time of testing. S'6/Gf •� FirmName ��¢t�i1 �par.rl��d�l Firm Address aa 3csU Gu G„�'//P/1.f/� i't�� Certified Tester(print) 'l�,�ip !'�jo/��,¢�Certified Tester(signature) g �--�z�j z"-2� /6 Firm Phone#� Cert.'fiester No. �1�,%r/�_Date * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS White- Ciry 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: j ,� , _ � CONTACT PERSON/PHONE: a — a — LOCATION OF SERVICE: !C�' � ,� '�'B�� Go _ , � r�; The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operaring within acceptable parameters. TYPE OF ASSEMBLY �educed Pressure Principle �Reduced Pressure Principle-Detector i_DoubleCheckValve ��-1Double Check-Detector f PressureVacuumBreaker '� Spill-Resistant Pressure Vacuum Breaker Manufacturer Pil�j�� Model Number�"��' �,z, Q`TSize� Located At �i¢Gl� �'�GL Serial Number r�,3,�/'j� 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 7, '� psid Held at�psid Opened at 3� Opened at Held at Initial Test Closed Tigh� Closed TightpQ psid psid psid Leaked� 1 Leakedl�! Didnotopen � I Didnotopen ' I 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 1 psid psid psid Test gauge used: Make/Model� /G/-Cj�s T�—j� SN: p y�j��? Date Tested for Accuracy: ,��Z�l/�S� Remarks: The above is certified to be true at the time of testing. Sf�GSr Firm Name/�ulfGrrl (o,ar��C_'l � Firm Address r,SCX� ,� C'��-72.�G £'x��r�/�i��F�� T.,. Certified Tester(print) 17Q11/i� /�D/�j�Certified Tester(signature) Firm Phone#��r�� Z�,�� 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 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) c P�� MAILING ADDRESS: �. $ ,i3� • •� , � �X^`7 djF CONTACT PERSON/PHONE: ,�,�C�/�? J/'7�- �2U,� 7 ��r' LOCATION OF SERVICE: lp�,� ;i�f"[��i��'r� '�300 �o�/-'r��, `,�: The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is cerrified to be operating within acceptable parameters. TYPE OF ASSEMBLY �educed Pressure Principle I IReduced Pressure Principle-Detector I Double Check Valve ��Double Check-Detector f IPressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker Manufacturer Gl��,� Model Number �'SC3 ;2 C�• Size � �� r-% Located At l�i�G�<' �'�rl,P/.�-GG Serial Number�2 3�'/� 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 ]st Check 2nd Check Held at�psid Held at�psid Opened at�� Opened at Held at Initial Test Closed Tigh� Closed Tigh� psid psid psid Leakedf 1 Leaked. 1 Did not open f ' Did not open � 1 Leaked'�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight i��] ClosedTight f�I psid psid psid Test gauge used: Make/Model�,lf��/�J��'.5� SN:f�� Date Tested for Accuracy: ��Z.��11� Remarks: The above is certified to be true at the time of testing. f��'S � Firm Name 1,/1��L�/�G�'t�L Firm Address�S'��,. C f,�2�/�L rr�'Y�u�� '�� /u �/�C!'/?�. '�' Certified Tester(print)��,�4lJri� ,��,��i�Certified Tester(signature) �� Firm Phone# �yZ,Z�4/��L,�9�� Cert.Tester Na.� �i�/�/,� �____�/�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: //�7� S, D��z�yi�t�. �f�?ssc� C' �'GL 'iX ��/� CONTACT PERSON/PHONE: 1��,j,r�I �l'�-Zri�? �':�� LOCATION OF SERVICE: �•p 7� S r3�Tl�� /�v, �3an 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 educed Pressure Principle CReduced Pressure Principle-Detector ��-1 oubleCheckValve �Double Check-Detector IPressureVacuumBreaker []Spill-Resistant Pressure Vacuum Breaker Size � �� Manufacturer /,/� � ,� Model Number D��a�� .L Located At ��f.C%t��/�GG Serial Number,.�-3,�'��/ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? f��`� 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 at7.Z- psid Opened at i�i l Opened at Held at Initial Test Closed Tight .Y Closed Tigh� psid psid psid Leakedf 1 Leaked'. 1 Did not open L�� Did not open �� ! Leakedi�� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight 1 1 Closed Tight-1 psid psid psid Test gauge used: Make/Model��/1_�.�'�j2s �/�.� SN: 2�G� f�r�'� Date Tested for Accuracy: �, ��,�/� Remarks: The above is certified to be true at the time of testing. Firm Name L ��`f�' �3nn �j�C�y�l,��.�iA� Firm Address/��''ad .S: �f,r�j7�'.� l,,i�� ii �1 i G/�////�.-� � `Ti�; Certified Tester(print)�� /r�� ertified Tester(signature) ��: Firm Phone# ��-�y;Z y.-,z-�.z9 Cert.Tester Na � � 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) �, ��TLr%!E �� MAILING ADDRESS: ��;��. �3�� o%'i�'F�G, '�� p�� CONTACT PERSON/PHONE: ��',�ii,¢�,�// �'j�_�2�1�7�;r�,Q LOCATION OF SERVICE: �1.�7,� S', ,c'�s-�Tc�y/� ,Qp��,� �v��c� •�. 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 �-1Reduced Pressure Principle-Detector ��I Double Check Valve C�Double Check-Detector ��PressureVacuumBreaker C1Spill-ResistantPressure Vacuum Breaker Manufacturer�/,�f�� Model Number Q(�� r Size�l� Located At '�Jf d,�/��ija �L�Serial Number��2, � v�j/ 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 lnitial Test Closed Tight� I Closed Tight I psid psid psid Leakedf 1 Leaked'�I Did not open �; Did not open �� 1 Leaked� I Repairs/ ��j-j-"f Materials �� ? Used f�l�l�' � Held at�psid Held at .��psid Test After Opened at�� Opened at Held at Repair Closed Tight�Y Closed Tight� psid psid psid Test gauge used: Make/Model�fG�j�S -�� --� SN: �7�10�'e�9�� Date Tested for Accuracy: �l,?!"//S Remarks: The above is certified to be true at the time of testing. ` FirmName��il C��.,u�✓�'c'-/.�G�UG irm Address��T�n S'; f�3/f's,�-L F r� � .� ��=--�Dn .��i��r, �Tx , Certified Tester(print) �i�//!%�,��'��ertified Tester(signature) Firm Phone# ��2`�/,�y�.Z�'.�-`� Cert.Tester No.,C��G�Q/l� ��,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 C�IECK ONE: IRRIGATION DOMESTIC � FIRELINE BACI�ZOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # LOCAITON OF SERVICE: ��5�.��T�l:��, ��, �� •�,�. -��—�� The bacictlow prevmtion asscmbly detailed below has beea tesud and maiatained as required bv TNRCC re��ulations aad is cerdfied to be operating within acceptable paramcters. ✓� TYPE OF ASSEMBLY Reduced Pressure Principle C Pressure Vacu�Breaker ^ Double Chcck Valvc o Amnosphere Vacuum Breaker Maaufact�uer �T�s' Siu /� j/ ��- , Modei Ivumber f�� %— Located At .��t�� /v�G.�i� C:�s�i f/�'S� s«i�N�ba �-95.�3� REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE V�CUUM BREAI�R Double Cherk Valve Assembly lst C3eck 2nd Checl: ReIief Valve Air Inlet Check Valve Inival Test DGClosed Closed Ti;ht o Opeaed at Opeaed at csid Tight Leal:ed o _.'�.�psid __osid R.P-�sid � I,eal;ed o �� Did not Opea O I,eake� O �P� and Matrrials Usod Test After DC-Closed Closed Tight o Opened at Opeae�at _asid Repair Tight � Dsid _osid RP sid The above is cerdfied to be true. Firm Name!-,�4�r� ��s��s.� �.�c5,C«tificd Tcsca l'�i4-!�//.� ,/�'�I��,�t'I Firm AddrGss�"�5'nv s,� c;��.-/�a� �,,�',,�Cert. Tester No.,�3/-'i�o/�3��%Date � �6 ��c'c> ��G.�fj�f ji� `%�'� (�suge # ��D 9�f 6� llate last accuracy tested ,Z White- Customer's Copy Yellow - City Copy Pink-Tester's Copy