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2016_0620 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 for recardkeeping purposes: � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � MAILING ADDRESS: CONTACTPERSON/PHONE: / �j �'L-�(� / - (752� LOCATION OFSERVICE: /-f-C�S' S. �5/� 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 �ouble Check Valve -l Double Check-Detector IPressureVacuumBreaker 'Spill-Resistant Pressure Vacuum Breaker Manufacturer ULJ.t� Model Number O�%Jj�/ Size �` Located At �i � Serial Number 6.,�t�� 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 Tigh� Closed Tigh� psid psid psid Leakedl �� Leaked� 1 Did not open (1 Did not open I�1 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_ I psid psid psid Test gauge used: Make/Model�,�, '��S� SN: (7'?V j��geS' Date Tested for Accuracy: 6- �� Remarks: The above is certified to be true at the time of testing. FirmName�e-�+•--�-��. ��S Firm Address �✓o�.rL�� Certified Tester(print� � ��Ir�- Certified Tester(signature)�`� �� Firm Phone#��"�-�.�-�—? Cert.Tester No. �6�,Y 6�.� Date 6�� * 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 DtaMESTIC F{RELINE V The following forrn must be completed fvr each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeepin�purposes: BACKFLOW PREVENTION ASSEtNBLY TEST AND MAII'VTENANCE REPORT �"-+� NAME OF PWS: CITY OF COPPELL PW �,,, S I.D. #0570040 (Customer) MAiLING ADDRESS: CONTACT PERSON/PHO]VE: j 9 7z'36/- �'7,rt� LOCATION UF SERVICE: .�'"� S, �o�ic� The backflow prev�ntion assembly detailed below has been testecf and maintain�d as,required by commission regulations and is eertified to be operating tivithin acc�epiable parameters. TYPE OF ASSE�1e1BLY — Reduced Pressure Principie R��uced Pressure Principle-Detector � ;Doubte Check Valve liDouble Check-Detector :-iPressureVacuumBreaker "'Spill-Resistant Pressure Vacuum Breaker Manufacturer �,cJ,�.7�, Model Number 7P� Size_� Located At ��,� ��Q Serial Number ��S 7� Is the assembly installed in accordance with manufacturer recommendations ancllor local codes? Reduced Pressure Princi le A,ssembl Pressure Varuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve l st Check 2nd Check Held at� �psid Held a[ Z+�psid Opened at_ Opened at Held at Initial Test Closed Tight!%� Closed Tighk �✓ psid psid psid Leaked : Leaked. ' Did not ope� Did nat open ' Leaked ' Repairs/ Materials Used Held at psid Held at psid Test After �pened ai Openc:d at He1d at Repair Closed Tight I ; Closed Tight ' psid psid psid Test gauge used: Make/Model l��+2� ��S`f SN: o �t��O�d�� Date Tested for Accuracy: � ` '�/� J�q Remarks: The above is certified to be true at the time of testing. FirmName��,r.,,.. /�II��, �?�,j' Firm Address�� 7� � ��a,�c,,� . ��'/,� Certified T+ester(pr�nt) �rs�ertified Tester(signature) �,..�C,C,,� �� Firm Phone#c�� -` S$'8 -`z'z�� Cert.Tester Nc�, �� 'uti �I�'� Date �-_z`�"�_ *TEST RECORDS MUST BE KEPT FOR AT LEAST THFiEE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTdC FIRELINE_� The following form must be completed fi�r each assembly tested. A signed and dated original must be submitted to the public waker supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAI�iTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. #0570040 (Customer) MAILING ADDRESS: CONTACT PERSOI�IfPHONE: �/S - z- l 6 7,r�a LOCATION OF SERVIGE; �c�� S- +�� The backflow prevention assembly detailed below�has been tested and ix9aintained as required by commission regularions and is certifred to be operating withim acceptable parameters. TYPE OF ASSE9NgLY Reduced Pressure Principle 'Reduced Pressure Principle-Detector � �Double Check Valve !Double Check-Detector -{PressureVacuumBreaker �':Spill-Resistant Pressure Vacuum Breaker Manufacturer ��'�� Model Number �D��Lt� Sir.e '��f Located At �� krl-�� Serial Number -�� Is the assembly installed in accordanee with manufacturer recommendations ancUor local codes? ; 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�• �psi Opened at_ _ Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid � psid Leakedi i Leaked' I Did not open ! Did not open _ ' Leaked , Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Ciosed Tight ; Closed Tight ' psid psid psid Test gauge used:Make/Model L�-��— ��.� �ly, v`7 a �f''� ��'� Date Tested for Accuracy: -�, - g• /"� Remarks: The above is certified to be true at the time�f testing. Firm Name ,,w�--- ��2 �� Firm Address_�¢�v-� ''/�j'? ��a.fG, V�� 7,;J�� Ce�rtified Tester(pri nt)��ertif ed Tester(si�nat�ure) � � ��--, � Firm Phone#!S'� S.5'�� Z�8� Cert.Tester No.��t�6 f�'� Date C-��Zv�/�, * 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 GoFy IRRIGATION DOMESTiC " FIRELlIVE The following form must be completed fvr each assembly tested. A signed and dated orig,inal must be submitted to the public water supplier for recordkeeping parposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAI9I�TENAIYCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570(J40 (Customer) MAILI�IG ADDRBSS: - CONTACT PERSONfPHONE: � S 7Z- �i - �'�S� LOCATION OF SERViCE: S �_ The backflow prevention asse�nbly detailed below has been tested and maintained as n�yuired by commission regulations and is certifieci to be operating within acc;eptable param+eiers. TYPE OF ASSE�VIBLY � -,Reduced Pressure Prineiple :'Reduced Pressure Principle-Detector � t�'bouble Check Valve Double Check-Detector -lPressureVacuumBreaker ';Spill-Resistant Pressure Vacuum Breaker Manufacturer GcJ��..-• Model Number �.S'� Size�_ Located At �•�_,� �jc��✓\ Serial Number � �3�� Is the assembly installed in accordance with manufacturer recommendations and/or local eodes? Reduced Pressure Princi le Assembt Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet ChcCk Valve 1 st Check �nd Check Held at�2 psid Held at Z' d psid Clpened at___, Opened at Held at Initial Test Closed Tighd� Closed Tight'� psid psid psid Leakedi ; Leaked.J Did not vpen I Did not open I Leaked ! Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight . : ClosedTight . psid psid psid Test gauge used:Make/Model �-tJ,.rQ, � ,� SN; d?��o�-� Date Tested for Accuracy: - -/� Remarks: The above is certified to be true at the time of testing. Firm Name_J��r��. ��.� Firm Address�c��_��"7 �� ?SI b� Certified Tester(print) � ��'�ified Tester(signature)� -�� C"� Firm Phone#_��.�v _�"� Cert.Tester No. R P� �►s� Date �� 2�'`,�" *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Y�llow-E;ustomer Gopy Pink-Tester's Copy IRRIGATlON DOMESTIC v FlRELINE The following form must be completed fvr each assembly tested. A signed and dated originai must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTEI�IANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #U570040 (Gustomer} � MAILtNG ADDRESS: CONTACT PERSON/PHOIVE• �j?Z, �;�/ ��e� LOCATION OF SERVICE: ��-' S_ (Zoa�4SZ The backflow prevention ass�mbiy detai(ed below has been tested and maintained as required bg� commission regulations and is certified to be operating within acceptable paraineters, TYPE OF ASSEMBLY ;Re uced Pressure Principle Reduced Pressure Principle-Detector � ouble Check'Valve I��Double Check-Detector -^PressureVacuumBreaker 'Spill-Resistant Pressure Vacuum Breaker Manufacturer l�/u� Model Number 17,�b Size � ?�' Located At S� �c.�Q�� Serial Number_� (,3 v��8� Is the assembly installed in accordance with manufacturer recommendations andlor lacal codes'? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check�alve l st Check 2nd Check Held at Z,�psid Held at z ��'psid Opened at_____ Opened at Held at Initial Test � Closed Tight�� Closed Tight �"' psid psid psid Leaked'', '. Leaked'.i Did not open ' 1 Did not open i Leaked Repairs/ Materials Used Held at psid Hetd aY psid Test Af#er Opened at Opened at Hedd at Repair Closed Tight; � Closeci Tight` ' psid sid p psid Test gauge used: MakeOMode1 LcJ�.c�.,,., ��a S'� SN: p�� '�� Date Tested for Accura�cy: �' J- /y Remarks: The above is certified to be true at the time of testin�. �� %�e"'f. 7�'°I? FirmNarne ^ �_�1�� Firm Address l�,c.,� "T'� �,�1�� Certifi�d Tester(print� - �; ' ,��ertified Tester(signature} ,�,� �� Firm Phone#_�'�S�� Cert.TesterNo.��c�o b / ,� � Date �- �'' � *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Ye(low-Customer Copy Pink-Tester's Gopy