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2016_0908 IRRIGATION � DOMESTIC FIRELINE The following farm must be completed for each assembly tested. A signed and dated ariginal 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: f 3D.3 G�r�►'►Q 1ei. �r Copp�e/l�'� �s�ol � CONTACT PERSON/PHONE: �-ew s S /�a�-I�ctS �2` —�/.�(, —�b 4�'b LOCATION OF SERVICE: ZG�� Seci c�%e� �r'J7 f3 1� 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 �Double Chec�C Valve �Double Check-Detector �7Pressure VacuumBreaker �l Spill-Resistant Pressure Vacuum Breaker Manufacturer �7'1".S Model Number DO'7—/�� QY Size z�� Located At RF}C/�- D�' 5�-1-�bQL Serial Number T��'Og3 � Is the assembly installed in accordance with manufacturer recommendations and/or local codes? i'�_'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 TighC�l Closed Tight }�. psid psid psid Leaked�� I Leakedf! Did not open �_1 Did not open � I Leakedl.�, Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight� Closed Tight[1 psid psid psid Test gauge used: Make/Model C� �'J Cc� �?��I� SN: �SOdC� Date Tested for Accuracy: � Remarks: The above is certified to be true at the time of testing. Firm Name�DDC?�� —�—�� Firm Address � � l_.t��Y' � , � � Certified Tester(print) � Certified Tester(signature) Firm Phone# 2��--��`�� Cert.Tester No. D(� Date � 8 ��o * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-Ciry 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: I�j03 i.t�rAY��'�e;� �i✓' �o��'fL ��l c1 CONTACT PERSON/PHONE: L�o S c.` ' 2f -4�(o -- b+�o LOCATION OF SERVICE: Z�b Sou ��y �"n �lVd 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 • f Reduced Pressure Principle I �Reduced Pressure Principle-Detector ��ouble Check Valve I �Double Check-Detector -7PressureVacuumBreaker ::'Spill-Resistant Pressure Vacuum Breaker Manufacturer �eh c� Model Number �`�� Size Z�� Located At �ro rrf o�' S�o�� Serial Number � �0�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e� 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 Z� � psid Held at��Z psid Opened at Opened at Held at Initial Test Closed Tight,�l° Closed Tight�` psid psid psid Leaked� Leaked� I Did not open 11 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 Closed Tight'� _ Closed Tight�.I psid psid psid Test gauge used: Make/Model��Ir1�J�GC� �0�Z��- SN: Z��OpU Date Tested for Accuracy: -l I I�I I �� Remarks: The above is certified to be true at the time of testing. Firm Name�pD�'-�' �—�Q Firm A ddress �JC�3 E�i' �i Y ��• �l � n . Certified Tester(pr:nt) 0.Clt u Certified Tester(signature) �� Firm Phone# ��—`�9�0'�(�`�v Cert.Tester No. � 7 Date 9 $ �� * 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: I 3 D3 f.t�r�lnq�e�C�'r ��p�e[1 Tx 7So i9 CONTACT PERSON/PHONE: ��5 (nac�c�, LOCATION OF SERVICE: ZG►O Sc t� �.w�� .�� (��vc� 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 1Reduced Pressure Principle-Detector ��-�bouble Check Valve I Double Check-Detector r'PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker � � i► Manufacturer Ft�e.O Model Number �S� Size � � �� Located At �ronT D-� �J1�4 Serial Number i� `ZS�� "7 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? e � 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.Z�� psid Opened at Opened at Held at Initial Test Closed Tight`�I Closed Tight ,� psid psid psid Leaked I Leaked�� Did not open 'i ' Did not open � Leakedl '� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight'�J ClosedTight��I psid psid psid Test gauge used: Make/Model �.�jm brd_c_o ��K SN: 'Z.-.��$CapC� Date Tested for Accuracy: �� Remarks: The above is certified to be true at the time of testing. Firm Name��e�I 1 S Firm Address � fY2 ��I'� lrEp �/( '�`• Certified Tester(prfnt) � �,�� Certified Tester(signature) � Firm Phone# y�� ( ��7 � Cert.Tester No.B��i�s8 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