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2016_0701 iRRIGATION � DOMESTiC FIRELINE The following form must be completed �or 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 I.D. #0570040 } (customer) L�,.xQ/� ��'°f'' . MAILINGADDRESS: 2nd�' YNr�r��,r .4+�e S�E� /O� �u�y t�- '�S'Z"i CONTACT PERSON/PHONE: ✓'�- N^ �f � - U-3 LOCATION OF SERVICE: o/ �A�lno�v p The baekflow prevenrion 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 � �uced Pressure Principle ::Reduced Pressure Principle-Detector v'DaubleCheckValve .'Double Check-Detector �;PressureVacuumBreaker '..Spill-Resistant Pressure Vacuum Breaker �i Manufacturer ��' Model Number �S� Size �' Located At /V� @..��-..-.. � �'� Serial Number t'I � � � �J Is the s�s+embty ir�talled in accordance with manufacturer recommendations and/or}ocai codes? Reduced Pressure Princi le Assembl �ressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check , b 2_. Held at 2 psid Held at� ' psid Opened at Opened at Held at Initial Test Closed Tight'.'� Closed Tight '� psid psid psid Leaked'" ! Leaked'J id not open ! Did nat open ' ! Leaked' ' Repairs/ Materials a Used ' Held at psid Meld at psid Test After �Ope`ned at_ Opened at Held at Repair Closed Tight _? Closed Tight[. ��yd psid psid - Testgaugeused: Make/Model G✓�.C.�C�.- T�-S'�' SN: 07��1o�/�k� Date Tested for Accuracy: � '9/� ` Remarks: The above is certified to be true at the time of testing. Firm Name �� P�vj Firm Address �1'�a'1� ?e17 G✓�', ��• '7S/6 a' Certified Tester(print)��e�h, l-.o��rtified Tester(signature) �"''f�"� Firm Phone# �v"� S3'o� ��,87 Cert.Tester No. ��6r4 `�S`7 Date � /.$^_1�_ *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY M.ANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRICsATION DOMESTIC � F1RELiNE The following form rnust be completed �or each assembly tested. A signed and dat+ed original � must be submitted to the public water supplier for recordkeeping purposes: BACKFL�W PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 � (customer) L��l,v �i'bp F . MAILING ADDRESS: 2 n��' 1'Vl e��!i�ar �l v�e S�E� t0� ��a-f� '�S�"'� CONTACT PERSON/�'HONE: ✓'`�- !n^ c f 1 - U-3 LOCATI(3N OF SERVICE: o/ {�� The backflow prevenrion assembly detailed below has been tested and maintained as required by commission regu[ations and is certified to be aperating within acceptabte parameters. TYPE OF ASSEMBLY �educed Pressure Principle 'i Reduced Pressure Principle-Detector -�✓Double Check Valve :_'.Double Check-Detector ^,Pressure Vacuum Breaker �':Spill-Resistant Pressure Vacuum Breaker Manufacturer Gc�s� Model Number d�'�N"'� Size �� Located At S•�� Lo r'�+-� � ]�Z��a�. Serial Nuixiber 9�� 3 � Is ihe assembly instatlled in aceordance with manufacturer recommendations and/or}acai codes? �' Reduced Presswe Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve l st Ch�k 2nd Check � , v 2.2 Held at psid Held at psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid Leaked! � Leaked':7 id not open : ' Did not open Leaked '. Repairs! Materials a Used ' Meld at psid Hefd at psid Test After �Ope'ned at Opened at Held at Repair ClosedTight'..� ClosedTightl ' psid psid psid � Test gauge used: M�ke/Model G�/�C�lCr�-+- �� -S'� SN: o7��v�/�g Date Tested for Accuracy: � "�/� ` Remarks: The above is certified to be true at the time of testing. FirmName �c.uv^�- � P�ros FirmAddress 9a�3� 7c/7 G✓�. ��t-• '�IS/6� Certified Tester(print) ey�,r�Y�� l:O��1c_�Ertified Tester(signature) ��SH�� `�y,/ Firm Phone# �'+�"�' S3'o� ��S`T Cert.Tester No. 1��6r�v `�S? Date_.�/�_f[� * TEST RECQRDS M[JST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANU�ACTURER'S REPLACEMENT PAItTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC ✓ F1REL�NE The following form must be completed �or each assembly tested. A signed and dated original � must be submitted to the public water supplier for recordkeeping gurposes: BACKFLUW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 ! (Customer) L�a.,r.a+/�v l�i'��' . MAILiNC ADDRESS: �d�r' 1'Yf �'��,r .4►�e S�E, /0� �c�-a--,, 1�- '75��( CONTACT PERSON/PHONE: ✓`�- N^ �r 1 - U- LOCATION OF SERVICE: o/ f�/A�1� The backflow prevention assembly detailed below has been tested and maintained as required by commissian regulations and is cectified to be operating within acceptable parameters. TYPE OF ASSEMBLY 'Reduced Presswe Principle :'Reduced Pressure Principle-Detector �oubleCheckValve :Double Check-Detector ;PressureVacuumBreaker 1Spil1-Resistant Presswe Vacuum Breaker ii Manufacturer �� Model Number G��'jY+�� Size � Located At S.�• �--� J�—.- Serial Number �`��" � Is the assembty ir�talled in accordance with manufacturer recommendations and/or lc�ca! codes? Reciuced Pressure Princi le Assembl Pressure Vacuum Breaker Double C!►eck Vslve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at r ��p�si Held at �� 6 psid Opened at Opened at Held at Initial Test Closed Tight;�"' Closed Tight � psid psid psid Leaked� 1 Leaked.-1 id not open . ; Did not open � Leaked ', Repairs/ Materials a Used � Neld at psid Held at psid Test After �Opened at Opened at Held at Repair CEosedTight'.� ClosedTight[_- psid psid psid - Test gauge used: Make/Model G�/�.4�Cw�.- T� -S-' SN: �7��10�1,�'� Date Tested for Accuracy: � "9�� ` Remarks: The above is certified to be true at the time of testing. Firm Name �C,�^- �� i'nS Firm Address ��3�'1� 7�? G✓�, ��• ?Sl 68 Certified Tester(print)�e».1�e'�h. �U,�c,.�rtified Tester(signature) �a�� `� Firm Phone# �'y"� S.So- z�8'l Cert.Tester No. P Pd�"' �� Date � /�'/�i * TEST REC�RDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFAGTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy �/ IRRIGATION DOMESTK FIRELINE The following form must be compteted �or each assembly tested. A signed and dated original � must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREYENTION ASSEMBLY TEST AND MAiNTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS i.D. #U570040 �� (Cus#c�mer) L�.,�/� �i'�'�' MAILING ADDRESS: 2 n��' 1'�f e��► Q v�2 S�E� /0� ��-a—,-1�- �3'�"+ CONTACT PERSON/PHONE: �"�- h^ t J 1 - U-3 LOCt�►TION OF SERVICE: o/ �/A.��o_�vA The backflow prevenrion 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 -�oubleCheckValve _'Double Check-Detector ��'PressureVacuumBreaker ' ;Spill-Resistant Pressure Vacuum Breaker Manufactuc�r �`�- Model Number o �' � f-�-1 Size 3�`� Locat� At /vy� + �� Serial Number �� 7� Is the assembly installed in accordance with�anufactucer recommendations and/ar local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Re�ief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at � ' psid Held at Z� �psid Opened at Opened at Held at Initiat Test Closed Tight� Closed Tight ,_� psid psid psid L.eaked!' ! Leaked'-1 id not open i ! Did not open , Leaked Repairs/ Materials s Used � Held at psid Hetd at psid Test After ;Ope`ned at Opened at Heid at Repair Closed Tight':J Closed Tight[: psid psid psid � Test gauge used: Make/Model G✓�.C�Cr�.- T�-S'�' SN: �7�`�1 v�J�g • Date Tested for Accuracy: � '�� ` Remarics: The above is certified to be true at the rime of testing. FirmName �� Pi'r�S Ficm Address �d��'1� ?�? G✓�, ��-• 7S168 Certified Tester(print)�.�ti'f�,��JQc.��rtified Tester(signature) ✓�� '''"?�'� �� o, ��6r.v G/,�'`7 Date Z �.�'/� Firm Phone# � S3' zx-a87 Cert.Tester No. *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USfi ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellc�w-Customer Copy Pink-Tester's Copy 1RRIGATION DQMESTiC FIRELINE V r The following form rnust be compieted �or each assembly tested. A signed and dated original rnust be submitted to the public water supplier for recordkeeping purposes: � BACKFL�W PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 � (G�stomer? L f,.��,iN �i��' . . MAILING ADDRESS: 2n�t' YNr.�!��,► .4s�e S�E, /0� ��—I�- "�SZ�1 CONTACT PERSON/PHONE: �'�- N^ c f / - U- LOCATION OF SERVICE: o/ f/A.ty�A The backflow prevention assembly detailed below has been tested and maintained as required by commission reguIations and is cectified to be operating within acceptable parameters. TYPE OF ASSEMBLY ]Reduced Pressure Principle rlReduced Pressure Principle-Detector -iDoubleCheckValve �ouble Check-Detector I-,FressureVacuumBreaker Spill-Resistant Pressure Vacuum Breaker Manufacturer l�� Model Number 7�� Size �� Located At �� r �� Serial Number �O o�-�� Is ihe assembty in�stalled in accordance with manufacturer recommendations and/ot local codes? Reduced Pressure Princi le Assembl Pressure Vacuum 8reaker Double Check Valve Assembly Re(ief Vaive Air Inlet Check Valve 1 st Check 2nd Check v � Held at � psid Held at 3' �p�s� Opened at Opened at Held at Initisl Test Closed Tight�� Closed Tight �_`""! psid psid psid Leakedi 1 Leakedi � id not open 1 Did not open : ! Leaked' ! Repairs/ Materials a Used ' Test After Held at psid Held at psid ��ed at Opened at Held at Repair Closed Tight', i Closed Tight! psid psid psid • Testgaugeused: Make/Model G✓�.C•�Cw�.- T� -S�' SN: O7o�/P�/�� . Date Tested for Accuracy: �i "9 I� ` Remarks: The abvve is certified to be true at the rime of tesring. FirmName �� xe Pi'nS Firm Address �8�L3�'1F 7GI? G✓�, ��-• 7SI�� Certified Tester(print) ,r�ti'��y l:O��rtified Tester(signature) `� Firm Phone# �y"� SSd- z�S7 Cert.Tester No. ��6a� `�S� Date ? /�'/[, *TEST RECORDS MUST BE KEPT FOR AT LEAST THRBE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pinlc-Tester's Copy 1RRIGATION DQMESTIC FIREL�NE '� The following form must be completed �or each assembly tested. A signed and dated original � rnust be submitted to the puhlic water supplier for recordkeeping purposes: BACKFLUW PREYENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 � (Customer) Li.�/� %�»"e'�� _ MAILING ADDRESS: 2 d�r' I'�? ��,r i4�e S�� /0� �,-t� "��"+ CONTACT PERSON/PHONE: ✓`�- N^ c 1 1 - U-3 LOCATION OF SERVICE: o/ {/AA��h The bsckflow prevention assembly detailed below has been tested and maintained as required by comroission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY Reduced Pressure Principle ;Reduced Pressure Principle-Detector J'�oubleCheckValve 'Double Gbeck-Detector -�PressureVacuumBreaker 7Spil1-Resistant Pressure Vacuum Breaker Manufacturer ��' Model Number �° ��'"`-� Size� Located At 5" �� V � Serial Number �� is the assembty installed in accordanee with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Va(ve 1 st Check 2nd Check Held at �'� psi Held at J�� psid Opened at Opened at Held at Initisl Test Closed Tight� Closed Tight � psid psid psid Leaked� 1 Leaked:^i id not open I Did not open � Leaked' ', Repairsl Materials s Used � Held at psid Held at psid Test After �Ope`ned at Opened at Held at Repair Closed Tight_J Closed Tight i_s psid psid gsid • Test gauge used: Make/Model G✓�•C�Cwti- T�,-�' SN. �7�l1 e�/�''8 Date Tested for Accuracy: � '�/� " Remarks: The above is certified to be true at the time of testing. FirmName �C,�v^�- �..q. Pi�vS Firm Address �d'�3� 7�7 G✓�. ��-• 7S16S' Certified Tester(print)��_��'rtified Tester(signature) `-�" ! T l Firm Phone# �'�"� SSo� zz-8'? Cert.Tester No.�'�a�'� `�S� Date ,� ��`/�i "`TEST RECORDS MUST BE KEPT FOR AT LEAST T'HREE 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 cornpleted 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) L�,,,�/N {�i'�� ' MA[LING ADDR�SS: ZadE' j'1�le_�w�� .,�Q►�e 5�� /Oti� �,-1�- '�5��i CONTACT PERSUN/PHONE: ✓"�- {-+��c J I�-{- U-3 7 LOCATION OF SERVICE: o/ {,/�+� t,,�d The backflow prevention assembly detailed belc�w has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parametexs. TYPE OF ASSEMBLY :;Reduced Pressure Principle 1Reduced Pressure Principle-Detector `-:',Double Check Valve i/rpouble Check-Deteetor ,lPressureVacuumBreaker !Spill-Resistant Pressure Vacuum Breaker Manufacturer !�� Model Number '77� Size �� Located At_/�•L�� r-w-�- �� Serial Number /�� ( ls the assembfy instatled 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 '� . � '�, 6 Held at psid Held at psid Opened at Opened at Held at � Initial Test Closed Tight� Closed Tight '�;� psid �sid psi�i Leaked' i Leaked' � 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 Closed Tight:_' Closed Tight'. i psid psid psid • Test gauge used: Make/Model G�/� �� `S�' SN: 4��10��1? Date Tested for Accuracy: �i "�/� ' Remarks: The above is certified to be true at the time of testing. Firm Name�C��- � �i�o� Firm A ddress ��f'1� 7�9�d G�./�f, ��. "7${6 8 Certified Tester(print) ,��,nti��,�rtified Tester(signature) �%-c�.� ��'�"�-��-- Firm Phone# �v"� S.S�- ��8'Z Cert.Tester No. ��6�� 5� _Date_._ ��- IS�' * TEST RCCOR.DS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy