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2016_0711 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 PRE VENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) �Q MAILING ADDRESS: l�DD �l D FGv CONTACTPERSON/PHONE� �i�c�J BLD� L.LC S��N- .?� - •��7 LocaTloN oF sExvicE: , l/Sv ��y�T� or,�r D�L, ' �' J 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 �DoubleCheckValve ��1Double Check-Detectar �PressureVacuumBreaker :lSpi11-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number ��— ��✓�ize O � Located At S.EN� OF I'/QO/�� !�u ��e"rial Numbe�C�'"'�� [ 7 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 �� psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight�, Closed Tight � psid psid psid ?_/�..�(P Leakedf ; LeakedL Did not open I J Did not open I Leaked � Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight I ClosedTight .l psid psid psid Test gauge used: Make/Model �✓��K/NS ��t —S sN: /00903�7 Date Tested for Accuracy: �'9 l�o Remarks: The above is certified to be true at the time of testing. FirmName ff �I/ST �/�� Firm AddressZO �. �• �, 7,S721p Certified Tester(pr�nt) �� r'''�Certified Tester(signature) Firm Phone# 2��—�lS' ��'<0 Cert.Tester No. D Date 7-I r-��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 recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) MAILING ADDRESS: 900 �i CONTACT PERSON/PHONE: eN C�, e, N -�/ - - 7 LOCATION OF SERVICE: /I D N 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 I IReduced Pressure Principle ❑Reduced Pressure Principle-Detector f�l�bouble Check Valve CDouble Check-Detector �'PressureVacuumBreaker I 'Spill-Resistant Pressure Vacuum Breaker Manufacturer �,tJ/�'�� Model Number �D7.M-3 Size � y Located At IU• �/ut� OF �/��- @ ✓I('ULT Serial Number �/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 1 st Check 2nd Check P��'S Held at�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight�. Closed Tight � psid psid psid `�►�(�� Leakedl 1 Leakedl�� Did not open ..� Did not open I��l Leakedl I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTightll ClosedTight��1 psid psid psid Test gauge used: Make/Model Gv/��/NS /�t-� SN: 1�p0��7 Date Tested for Accuracy: ��/�� Remarks: /1/ iuC" r�� f D /�vGr =' �D�� !� 9�So 3 4� The above is certified to be true at the time of testing. Firm Name � �uSf ✓��"� Firm A ddress � � G U9A�1D l(. Certified Tester(print) �� Certified Tester(signatur ��Z� Firm Phone# '��7�� 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 I.D. #0570040 (Customer) � � MAILING ADDRESS: AO �� CONTACT PERSON/PHONE: / O LLC. �S � �� - '� Z LOCATION OF SERVICE: �I50 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:1Reduced Pressure Principle I :Reduced Pressure Principle-Detector �IDoubleCheckValve �Double Check-Detector �_'PressureVacuumBreaker �1Spi11-Resistant Pressure Vacuum Breaker , I ��/ Manufacturer G✓�� Model Number 7.�? - D�DA��tV Size Located At ti .f/� AF �� //Ul.f Serial Number Q� � �'�� 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 P� Held at �•G psid Held at� ` psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight I� psid psid psid �.�/�1�p Leakedl ' LeakedC' Did not open l Did not open '_' Leakedf 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 Wi��/R!S /�j —S SN: ( ��3�7 Date Tested for Accuracy: .�'��/�o Remarks: The above is certified to be true at the time of testing. FirmName � /„✓ST JA`�� Firm Address �� . 7S/2-�i Certified Tester(pri nt)/�/C�I¢1�,� l/5� Certified Tester(signatur Firm Phone# ,?/�,3/��pQ Cert.Tester No. BPOD/0�7� Date 7��/�+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 DOMESTIC FIRELINE k 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 LD. #0570040 � (Customer) MAILING ADDRESS: IR O O � o f � CONTACT PERSON/PHONE. N $ 1-�-C-. N''4Ls�/✓'Z� � ' %t LOCATION OF SERVICE: 1 O D N 17R. 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 I Reduced Pressure Principle 1Reduced Pressure Principle-Detector J�oubleCheckValve C IDouble Check-Detector �PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer �/�5 Model Number ��/i'�3 Size ,��f!/ Located At s• ,f/DE oF � la�I�cJLT Serial Number �.3�s3 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 ��I psid Held at �O psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight �j psid psid psid ��--�� Leaked' I Leaked'` I Did not open �, Did not open Ll Leaked�� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTightll ClosedTight'��I psid psid psid Test gauge used: Make/Model �/��/NS O�.t- $- SN: 10090��7 Date Tested for Accuracy: �`9— ��P Remarks: ��'ATLNE � `� "/0 �� -�O � (o��-'�3`j O The above is certified to be true at the time of testing. n � 1 �.•,./ � Firm Name H' �IQI�r �1�170w Firm Address 2� �i� / , 7�/Z(o Certified Tester(pris�t)�GK� /�� Certified Tester(signature Firm Phone# �/rr.3/S� ��g0 Cert.Tester No. BP�Q37� Date 7"��-T�� * 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