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2016_0621 IRRIGATION DOMESTIC FIRELINE� The following form must be cornpieted 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: CONTACT PERSON/PHONE: ,�t� q 7 Z�' 3�r/� 6 7�S LOCATION OF SERVICE: 6va �. �iE,,�Q The backflow prevention assembly detaiied below has been tested and maintained as required by commission reg�lations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ]Reduced Pressure Principle R duced Pressure Principle-Detector Double Check Valve �uble Check-Detector i-!PressureVacuumBreaker -'Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number /�� Size � Located At S• �' ��` Serial Number �� Is the assembly installed in accordance with manufacturer recommendations and/or locai codes? Reduced Pressure Princi le Assembl Pressure Vacuum 8reaker Double Check Valve Assembly Relief Valve Air fnlet Check Valve 1 st Check 2nd Check -f7 Held atZ�� psid Held at� � psid Opened at Opened at Held at � Initial Test Closed Tight� Closed Tight � psid �sid psid Leaked� i Leaked'I Did not open ' Did not open i Leaked' , Repairs/ Materiats e Used Hetd at psid Held at psid Test After •Opened at Opened at Held at Repair Closed Tight'::I Clased Tight :;: psid psid psid � Test gauge used: Make/Model /,c%Jl�-^ �I �t � SN: 07d 9G'�f�'� Date Tested for Accuracy: e�i-�'/- /(�a " Remarks: The above is certified to be true at the time of testing. '�o'q�-d,L 7�j� Firm Name��,ee; �� Firm Address�T��t.. `7��.�,8 Certified Tester(print)�n.►P� �/3x✓ Certified Test�er(signature)��„�� Firm Phone# �� 5.�� - Z�� ? _Cert.Tester No.�/� v�a 6�.5�� Date � � z�'�-� *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 � RRELINE The following form rnust be completed for each assembIy tested. A signed and dated original � must be submitted to the pubtic 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: CONTACT PERSON/PHONE: �s Z "' 3 �' b�'" LOCATIdN OF SERVICE: c�z� S- I"Zdyc� � The backflow prevention assembly detailed below has been tested and maintained as required by commission regvlations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY iReduced Pressure Principle ';Reduced Pressure Principle-Detector �oubleCheckValve ;Double Check-Detector '-1PressureVaeuumBreaker _ Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number G1 U!�/� ( Size � Located At �� \``� �Y�� Serial Number �s� �� Is the assembly instalied in accordance with manufacturer recommendations and/or loca! codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air[nlet Check Valve 1 st Check 2nd Check v Held at Z psi Held at J��psid Opened at Opened at Held at Initial Test Closed Tight� � Glosed Tight [�l� psid psid psid Leaked' ' Leaked'.i id not open i Did not open ' ! Leaked ' Repairs/ Materials s Used � � Held at psid Held at psid Test After -Opened at Opened at Held at Repair Closed Tight!:I Closed Tight':' psid psid psid - Test gauge used: Make/Model r �� SN: �'�'�9�� Date Tested for Accuracy: b '"l/'','1� ' Remarks: _ The above is certified to be true at the time of testing. �-- �� '�-�- ��!�? FirmName�e�-�'�e-e Firm Address 1�i-�L- �7'� • �7�/b� Certified Tester(print�� ''se�i��-✓Certified Tester(signature)� ��-- Firm Phone# dr�— .S�vrp ' ��--��1 Cert.Tester No.��O gr-� � 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 DQMESTIC FIRELlNE � 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 ANU MAINTEIYAPICE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 ` (Custom.er) � MAILING ADDRESS: CONTACT PERSON/PHONE: 1S � .� � q 7 Z_ - 3� �—L�� LOCATION OF SERVICE: �o c�,o S� �Ya� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulatians and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY :Reduced Pressure Principle ':;Reduced Pressure Principle-Detector 7DoubleCheckValve iDouble Check-Detector :i.�ressureVacuum Breaker ` :Spill-Resistant Pressure Vacuum Breaker Manufacturer ��-� Model Number ofl `71'yt 7 Size �r� Located At /(/� �it...� Serial Number ��?� Is the assembly installed in accordance with manufacturer rec;ommendations and/or local codes? Reduced Pressure Princi 1e Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Vaive 1 st Check 2nd Check 2 Held at �� psid Held at�' �psid Opened at Opened at Held at Initial Test Closed Tight;� Closed Tight � psid psid psid Leaked ' Leaked.� Did not open ' Did not open ' Leaked ' Repairs/ Materials j Used Held at psid F{eld at__psid Test Afier •Opened at a Opened at Held at Repair Closed Tight'i ; Closed Tight' ! psid psid psid • Test gauge used: Make/Model �.-P��;,._ ��5+ SN: D�U �l a�� Date Tested for Aceuracy: ��J� ` Remarks: The above is certified to be true at the time of testing. J�� 7�- ��7 7 Firm Name /�� f/" '-�, �� Firm Address�.�K �S'/� � Certified Tester(print)�,��-�t3.�Certified Tester(signature) �� Firm Phone# ��SvG� z�-�"7 Cert.Tester No.�� '� ��3 7 Date 6" 4'� ��"6 *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER"S REPLACEMENT PARTS White-City Copy Ye11ow-Customer Copy Pink-Tester's Copy IRRIGATION D�MESTIC FIRELINE The following form rnust be completed for each assembly tested. A signed and dated original � must be submitted to the public water supplier for recordkeeping pu�poses: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570U40 � (CusCorner) � ' MAILING ADURESS: CONTACT PERSON/PHQNE: rS ..Q �-- �(� i� 67� LOCATIaN OF SERVICE; d S'. The backflaw preventian assembly detailed below has een tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ' iReduced Pressure Principle `_Reduced Pressure Principle-Detector D�ubie Check Valve Double Check-Detector a'PressureVacuumBreaker 'Spill-Resistant Pressure Vacuum Breaker Manufacturer 1,tJ�� Model Number `IA/� Size (I Located At /l��'. �� Serial Number /�� f�� .� `� '7 Is the assernbly installed in accordance with rnanufacturer recommendations and/or locat codes? 1 Reduced Presseue Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at 2� psid Held a�� psid Opened at Opened at Held at lnitiaf Test Closed Tight� Glosed Tight .� psid psid psid Leaked ! Leaked' 1 Did not open ! Did not open ' i Leaked. ' Repairs/ Materials � Used � Held at psid Hel�f at__�isid Test After •Opened at Opened at Held at Repair ClosedTight' I. ClosedTight,:', psid psid psid � Test gauge used: Make/Model LcJ�l�., �C-�S SN: 17 �J `��-8� Date Tested for Accuracy: �- �/� " Remarks: The above is certif ed to be true at the time af testing. � � �'� r�� 7 y � FirmName �c�.�, l')� I�7�a; Firm Address��( �, `7�/6� Certified Tester(print�C��?Iw l��G�✓ Certified Tester(signature) � �`�''�'� Firm Phone#c�'�'4s� 5S�r `=—�-��' Cert.Tester No.��r S`'7 _Date__ 6�Zf— /� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMEN?PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELI�lE � 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 REFORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 � (Customer) � MAILING ADDRESS: CONTACT PERS�N/PHONE: /S 2- 3�r- 6'7�� LOCATION OF SERVICE: �� S. -:� ,� The baekflow prevention assembly detailed below has been tested and marntained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY [:Reduced Pressure Principle !Reduced Pressure Principle-Detector G'bouble Check Valve :'Double Check-Detector -'PressureVacuumBreaker lSpi11-Resistant Pressure Vacuum Breaker Manufacturer 1�� Model Number 4�'7 � � _Size� Located At .� !�� V k.�u��T Serial Number ��'7�''Z Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum 8reaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at I j�psid Held at r� (`' psid Opened at__ Opened at Held at Initial Test Closed Tigh� Glosed Tight *'� psid psid psid Leakedi i Leaked:�l Did not open ; Did not open } Leaked `: Repairs/ Materials e Used � � Held at psid Heid at psid Test Af�er •Opened at Opened at }ield at Repair Closed Tight'.i ClosedTight'. psid �sid psid � Test gauge used: Make/Model Lt/i�l��v�- ��_SN: a 7�g'�� Date TestedforAccuracy: �� 9' /� ' Remarks: The above is certified to be true at the time of testing. P� �� 7�� Firm Name �t/�.-� �� ' Firm Address �✓�• �y �S/�� Certified Tester(print��ti� ��2c� Certified Tester(signature}��=�� ✓ Firm Phone#d'�� .'i`�J � 2-"��'� Cert.Tester No. � P o c� t"'�'S/�ate � '' ��—�� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-Gity Copy Yellow-Customer Copy Pinfc-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 A1�1D MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570Q40 � (Customer) ' MAI�ING AI�DRESS: CONTACT PERSON/PHONE: i 5�___ _�.�— g'?Z ' .3 /-� G 7�� LOCATION O�'SERVICE: �o� 1'. �y a.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 :iReduced Pressure Principle �Reduced Pressure Principle-Detector �!'ISouble Check Valve ,Double Check-Detector �Pressure Vacuum Breaker ` ':Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number pt��/'121 Size � Located At_�� ..�� Serial Number �� 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 Vaive Air Inlet Check Valve 1 st Check 2nd Check � Held at Z� psid Held at �� psid Opened at Opened at Held at Initial Test Closed Tight� Glosed Tight ?� psid psid psid Leaked; i Leaked I I id not open : Did not open ! Leaked; ; Repairsl Materials s 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 l��l'�- T� � SN: O 7U g d�� Date Tested for Accuracy: 6 '�"/� ' Remarks: The above is certified to be tn►e at the time of testing. �� FirmName ��,� �� `�� Firm Address_G��l�, �L �.�/-�d' Certified Tester(print��ertified Tester(signature) � � �--�'�� Firm Phone# ��— �`��'Z��Cert.Tester No.�_�� 6�,�7Date_� —2��_ *TEST RECORDS MUST BE KEPT FOR AT LEAST THR�E YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy