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RPZ_2016_0518 IRRIGATION DOMESTIC V FIRELINE The following form must be completed for each assembly tested. A signed and dated ariginal 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: �5 !f �.��f'�1- S{` Ar �`��f `� CONTACT PERSON/PHONE: Gw,.�-�.�a � �r' C�`�o? - c?11 �' S� LOCATION OF SERVICE: SL�S c��,�{v�, S� 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 Double Check Valve I Double Check-Detector �'PressureVacuumBreaker ISpill-Resistant Pressure Vacuum Breaker �'�'' �� M�' � 1 Size � li Manufacturer �e. � Model Number Located At �� S��F �� -�� Serial Number �6� oZ�a1 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�P•� psid Held at�psid Opened at �-� Opened at Held at �itial Test Closed Tightll�--' Closed Tight IT.✓ psid psid � psid 45� Leakedl I Leaked'��1 Did not open f 1 Did not open ' '� Leakedl Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight��7 ClosedTight[�.'�� psid psid psid n �L Test gauge used: Make/Model`�6/rt�o 1?LQs?��- �l�'-.�at}-�� SN: a/(y�2a a�� Date Tested for Accuracy: �C��'`��(i Remarks: The above is certified to be true at the time of testing. � Firm Name .c�u`t /"��ai bUG�`�i�Ps"�i� Firm Address �Y�7� ��ll�i.�, �/. ��c. �/� �S4/3 � Certified Tester(print�i�e-/ ��/� Certified Tester(signature). � .�<�-� Firm Phone# �J Y `d�g��/l� Cert.Tester No.��a��(o��S Date s l�'/ 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 recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) // MAILING ADDRESS: SC5 � f{o�s��t'� ��, G„�,�+c��, �i �5v/ � CONTACT PERSON/PHONE: �J u r,..d �'�,r-¢�Ce�Ic� �- �(-- S"� LOCATION OF SERVICE: ��S / o s��c� �fi' 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 ��duced Pressure Principle �Reduced Pressure Principle-Detector I i Double Check Valve I Double Check-Detector [1PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer �`Uc{��5 Model Number ��U��'�� Size J � �1 L Located At ��C$.h ��-�� f��,��r Serial Number �� 93�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? .a 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 3�� Opened at HeLd at � Initial Test� Closed Tightl� Closed Tight °i� psid psid psid � �(��S Leaked; I Leaked��'� 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 Closed Tight��1 Closed Tight��' psid psid psid Test gauge used: Make/Model Cd�-6fiaca yp� (��U. 'Tl�S SN: ��aabl CoCa Date Tested for Accuracy: ��a�f��s� Remarks: The above is certified to be true at the time of testing. FirmName �ek��- �p�� ,�y�+r��1v 1��Firm Address ��([�' ��r(or,�. C�, r/��t�,, � ��G�l!' � � Certified Tester(print).T/'��La��L'd`�- Certified Tester(signature � �� Firm Phone# �'j� -�IB�[o�j(i CertTesterNo. 13�°a�a/(�(�� Date � �� a * 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: �0� �4��tsY� %�f �o � ��I CONTACT PERSON/PHONE: a r ar ��d — o��(�b�S�� LOCATION OF SERVICE: SU� �cr S' 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 [l�duced Pressure Principle ❑Reduced Pressure Principle-Detector '�IDoubleCheckValve �1Double Check-Detector :1PressureVacuumBreaker -1Spi11-Resistant Pressure Vacuum Breaker Manufacturer lh.l�+.� Model Number L FLO � �� Size � d Located At ��G� ��.e,/Z GC�2 �`�r�?S-�.�� Serial Number �� !J Is the assembly installed in accordance with manufacturer recommendations and/or local codes? 2 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 �-"� psid Held at�•� psid Opened at �• � Opened at Held at Initial Test Closed TightltL Closed Tight �-� psid psid psid �� Leakedi 1 Leakedl I Did not open I- Did not open : 1 Leakedi Repai rs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight I�1 Closed Tight-_I psid psid psid Test gauge used: Make/Model �ak.b/aco �U-o2pU-'Tl�S SN: C}(Q ao�o?(o�i� Date Tested for Accuracy: ��a�J �(S Remarks: The above is certified to be true at the rime of testing. Firm Name •�� 'F �y ��o�✓��vj Firm A ddress I�/�� Y(��¢, (�� <l�n. ,� �Sa/ � Certified Tester(print}��"�e� L��'� Certified Tester(signature�.—s��.1� Firm Phone# pr�y� a �$�c�y�7 Cert.Tester No. �nDUI�� Date � l� � * 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