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2016_0602 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�,3 Y l-�ke s�Livlr� ('�/'�'PlI, %7�. `7.5 O /�j CONTACT PERSON/PHONE: SQS 0 l� �,i�� CJ� 2 - 2!j9- f�b UlI LOCATION OF SERVICE: %�2 34 ��,,��ve 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 ': 1Reduced Pressure Principle-Detector �� 1 Double Check Valve �QDouble Check-Detector ' ,'PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker /r Manufacturer �P p's P�i Model Number �1)// Size � Located At /�Id,J p}��'/A�; /✓1 l�c?�°/f Serial Number �1 QO J�2 5 2 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 ��S Held at '�� psid Held at '��C�psid Opened at Opened at Held at Initial Test Closed Tighti� Closed Tight �' psid psid psid Leakedf ; Leakedl I Did not open ,�I 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� '� ClosedTight��7 psid psid psid Test gauge used: Make/Model ZI/;/k��rS `T(y',S SN: /2./2 0 f��(P Date Tested for Accuracy: � -/�I'/� Remarks: The above is certified to be true at the time of testing. Firm Name ��'e L✓�f�-,�'��/�- rr'o fPcf��tiFirm A ddress�a��,C�J/�"5��7,/CJ'�lr• �/(_��7� Certified Tester(pri nt) �r�(f��/r4��,�� Certified Tester(signature) Firm Phone# S�I�' J/1- 4�/C9 S Cert.Tester No.��/�U�ygj'��/ Date � '2—�� * 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: �/ �' � � �� 7 �9 CONTACT PERSON/PHONE: - � 9 - 00 LOCATION OF SERVICE: J•,?��/ �.D�t'S' ?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 C=Reduced Pressure Principle �Reduced Pressure Principle-Detector �Double Check Valve �Double Check-Detector '-,�PressureVacuumBreaker I Spill-Resistant Pressure Vacuum Breaker Manufacturer N�°/'f�'Y Model Number DC Size �� Located At /V l✓ � ��. /�j (A��/j� Serial Number ��/ 2 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 �'�S� Held at �P� psid Held at�(Z psid Opened at Opened at Held at Initial Test Closed TightP( Closed Tight Ij(� psid psid psid Leaked�l Leaked'��1 Did not open f 1 Did not open I�1 Leakedl 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 IA/��/��i�S ��j'� SN: 1 z�ZU��Co Date Tested for Accuracy: 2'/�1 -/� Remarks: The above is certified to be true at the time of testing. Firm Name�%��/,��r��i'�'i�tl��'�a�c�c�i� Firm Address pvlg0�'77/�'S��,1��.�� 7��77 Certified Tester(print)� o �f1/f1 �`'� Certified Tester(signature) � Firm Phone# ��7C 7"yC�� Cert.Tester No. �P��y��1 Date �i �%�p * 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) MaiLiN� aDDREss: 1�3Y L��N ,�erP, ('o��r=// 7l, 75 D/S CONTACT PERSON/PHONE: �T�t'.5o�r ,�r�'��,C- 971�,219-b'�00 LOCATION OF SERVICE: �J�l��f 0��j/(��. I��/�r�f�l°' 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 �D Double Check Valve ' 1 Double Check-Detector 7PressureVacuumBreaker ;Spill-Resistant Pressure Vacuum Breaker Manufacturer �/{/¢,�,s Model Number � 07r'y1 / Size�_ Located At %f0�,f�D �_d v;�� ,�y�j�F,��j^ Serial Number �l� 7 3 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? S/�S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check 1""� Held at �`� psid Held at ��/psid Opened at Opened at Held at Initial Test Closed Tight'�' Closed Tight,�' psid psid psid Leakedl I Leaked�l Did not open i J 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 I '�� Closed Tight=.J psid psid psid Test gauge used: Make/Model�j/��s�/�� SN: l Z��G�� G Date Tested for Accuracy: ,�'�� Remarks: The above is certified to be true at the time of testing. Firm Name f/I`P(�¢j�C'r� re.��/�of�tl;m�Firm Address yo �oX ��yr��,��,T.f'� 7/��7 Certified Tester r;nt � (p � ) �C°��li'��d�Certified Tester(signature) T".Z�.�G2��_� Firm Phone# �'f7 - 7/7- yfpS" Cert.Tester No. R/��f�/S��/ Date (n`Z�rCo � * 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 v 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 far recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: ��3� �c7�rt�S��C„_(e,9�"l'f�� Ti�, 7 SC�f� CONTACT PERSON/PHONE: ��i�p�2�t /iC- G17�. 2 8 9- �(�Od LOCATION OF SERVICE: %�2 3�/�q��,� 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 C1Reduced Pressure Principle-Detector �(Double Check Valve f�i Double Check-Detector I �PressureVacuumBreaker �Spill-ResistantPressureVacuumBreaker Manufacturer �� Model Number (�D 7%�'// Size � Located At IA�`P,�f/I �f�vi�� /��fc°r Serial Number gl �� / Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Y�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 Initial Test Closed Tight7� Closed Tight jrtil psid psid psid Leaked f '� Leaked l.� Did not open I I Did not open � 1 Leaked'�. Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight L7 ClosedTight� ; psid psid psid Test gauge used: Make/Model )i(/i//li�s �G's SN: �Z/z ('U;�(�i Date Tested for Accuracy: s? "�� Remarks: The above is certified to be true at the time of testing. Firm Name�/�/��P/;S.f✓vi;� ��'�'�iuf�G�io.�,Firm Address l��/6,r»�s �,�t�� /��1�1 Certified Tester(print)f�/�,�jv,r�� 2d�ZCertified Tester(signature) �.t�� Firm Phone#�')7-7/7� `��5 Cert.Tester No. J��G�/`�� Date � ^��1� * 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