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2016_0908 ✓ 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: 13�� Ot►'iC�l�/' ��r (.�+Q�oQ.I�i� 7,5��1� CONTACT PERSON/PHONE: ��u+r'S /Yf�tLii�S" ZJ�I— �F9�O—SO'�fV LOCATION OF SERVICE: �C�D ct� Of1 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 �7Reduced Pressure Principle-Detector �Double Check Valve '�-'Double Check-Detector �PressureVacuumBreaker f 'Spill-Resistant Pressure Vacuum Breaker Manufacturer �'eh v o Model Number ��b Size 2�� Located At�� Serial Number /'� d�3�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e 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 ��%Z psid Held at�psid Opened at Opened at Held at � Initial Test Closed Tight�f Closed Tight� psid psid psid Leakedl I Leaked I Did not open I 1 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 i J Closed Tight�_I psid psid psid Test gauge used: Make/Model �f�'1�ro�C� ��`�-d� �C SN: Z5 e�0� Date Tested for Accuracy: ��8/�S Remarks: The above is certified to be true at the time of testing. Firm Name��0�� .L S� Firm Address ��ra/1 i'' �if✓ � �l�` �/`� �� Certified Tester(print) i.'t`��t Certified Tester(signature) � � Firm Phone# ��`f -7 / ��Q�U Cert.Tester No.,C��7sg 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 recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) /� MAILING ADDRESS: 130� �rctrr /er (,;�. �j p�� '7�/g CONTACT PERSON/PHONE: C+ti l3' !' .5 �-�`�-4 9� �- d�{o LOCATION OF SERVICE: 1,100 �,� D� 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 i�KDouble Check Valve C Double Check-Detector � PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker � �, r Manufacturer �-� C�U Model Number � Size Located At �c,j��2T �� Serial Number �f�73�c�S Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �PS 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 ��L psid Held at Z.Zpsid Opened at Opened at Held at Initial Test Closed Tightlyl' Closed Tight�l psid psid psid Leaked�� I Leakedf-1 Didnotopen .l Didnotopen �I Leakedf� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight-7 ClosedTightl I psid psid psid Test gauge used: Make/Model �/h�C.c� �� Z�OT� SN: 25��OC� Date Tested for Accuracy: ��/g f/� Remarks: The above is certified to be true at the time of testing. Firm Name �D�JPI` �' �� Firm Address �3�.� u//'CXI� ✓ �1�� `-a P�l', '�`- Certified Tester(print) /� ° Certified Tester(signature) � Firm Phone# ��`'�' '`/'ll0-DQ�(/ Cert.Tester No,��67�J� 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 1.D. #0570040 (Customer) MAILING ADDRESS: �3D3 ��- I��"��' � e�� X ��C 9 CONTACT PERSON/PHONE: �CwiS L'.�L7S '�l�- (o- D� o LOCATION OF SERVICE: D w 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 lReduced Pressure Principle-Detector �Double Check Valve 1 Double Check-Detectar �PressureVacuumBreaker ��ISpill-Resistant Pressure Vacuum Breaker �- �r Manufacturer �C b�c� Model Number �'S 5 O Size Z Located At �Ti CC�et ��TE�3 Serial Number /`� � 7 3� Is the assembly installed in accordance with manufacturer recommendations and/ar local codes? �'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 Z� psid Held at �� zpsid Opened at Opened at Held at Initial Test Closed Tightl�k' Closed Tight�`I psid psid psid Leaked'1 Leakedl� ` Did not open -.] 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��i Closed Tight:_I psid psid psid Test gauge used: Make/Model D!'zt t- Z� '�°�Q �%L SN: Z$B�dU Date Tested for Accuracy: �/' /8 6 Remarks: The above is certified to be true at the time of testing. Firm Nam��J%��/ —�5� Firrn Address �� wl'�i�/� e�'�' �-J� � ��r� Certified Tester(prant) ,LJCLV � Certified Tester(signature) � Firm Phone# ��`t�`T 1� r�'f�� Cert.Tester No. p/ �� Date I 71� �� * 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) �l /I f MAILING ADDRESS: �D 3 (,�rct �er l��r l-D �e/��' '�5p/ q CONTACT PERSON/PHONE: LGw I',S /YI QS 2� - `� C D LOCATION OFSERVICE: �OD Ccatv O`Y 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 Check Valve �Double Check-Detector -IPressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer F-��f�D Model Number �S�V Size �� Located At (i f.��e'� `�� -7 Serial Number � D'� 3�O Is the assembly installed in accardance with manufacturer recommendations and/or local codes? �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 2�� psid Held at �=Z-�psid Opened at Opened at Held at Initial Test Closed Tightl�' Closed Tight � psid psid psid Leaked.1 Leakedf Did not open ' I 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 7 Closed Tight I ' psid psid psid Test gauge used: Make/Model L.d/►1 p/^�Cc� `t0A 2O� i� SN: 25gOC7U Date Tested for Accuracy: �! l B'� � '"J Remarks: The above is certified to be true at the time of testing. )l x �-,, Firm Nam��p{�/! �� Firm Address �J� ��'� lP� «' �ll`l`� Certified Tester(print) � � e�� Certified Tester(signat�re) Firm Phone# Zl�-T9(p� �7� Cert.Tester No�Oc.Vpl�B 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 far 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�� l� fl r' �d `v ��I \X �� CONTACT PERSON/PHONE: l�i� t a5 Z� - 4 �— 0�O LOCATION OF SERVICE: 4�Op CvEJ O'y 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 1Reduced Pressure Principle-Detector '�ouble Check Valve �-�Double Check-Detector -1PressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker Manufacturer 1—�6 t� Model Number �'S�L� Size 2�r Located At ��C�G� l��1-7f Serial Number � �7�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �je 5 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 l ' � psid Opened at Opened at Held at Initial Test Closed Tighti�l' Closed Tight�4 psid psid psid Leakedl�l Leakedl� I Did not open '� 1 Did not open � 1 Leakedl '� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ ClosedTight C�� psid psid psid Test gauge used: Make/Model 6 C 7�— �� !� SN: 25$OOcJ Date Tested for Accuracy: �� /� Remarks: The above is certified to be true at the time of testing. Firm Name�BAP/l ..L� Firm Address ��D��l`a�� '' 1..��►� � P/li � Certified Tester(print � � ° Certified Tester(signature) Firm Phone# Z�`C `T(�—��YC�' Cert.Tester No�rQ(it/6�5g Date � � ��v * 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) � Mali.iN�aDDREss: 13 d� c�r�� 'r C�r��1 `�x �5019 CONTACT PERSON/PHONE: ��iS Mac-i o� Z�4-��t l�—�[J�jb LOCATION OF SERVICE: �D� e,e> t�y 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:Reduced Pressure Principle �Reduced Pressure Principle-Detector �bouble Check Valve C Double Check-Detector f PressureVacuumBreaker i Spill-Resistant Pressure Vacuum Breaker Manufacturer ��.,, Model Number �b� Size Z`� Located At �' � �'R�-e"rro Serial Number b�J�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? veS 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 2�5 psid Held at Z••O psid Opened at Opened at Held at Initial Test Closed Tight�'f Closed Tight I`l� psid psid psid Leaked f�1 Leaked' I Did not open [7 Did not open [] Leaked� I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight G� Closed Tight.�I psid psid psid Test gauge used: Make/Model ��~ Z�� TK SN: ZSgC�bC� Date Tested for Accuracy: � 8 /S Remarks: The above is certified to be true at the time of testing. /� ) ' \ �� FirmName l�0ifl p��l i SD Firm Address �� UJI�R '1 �i� � �� Certified Tester(print ��0� 1 Certified Tester(signature) �� Firm Phone# 2'''T—'T-1� n�" Q�Cert.Tester No. T QD� �S� 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