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2016_1010 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) MAILINGADDRESS: (�j� �e�„J�- ��,�� CONTACT PERSON/PHONE: LOCATION OF SERVICE: I S$o a.��- �� 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 4i�ieduced Pressure Principle [-iReduced Pressure Principle-Detector ❑DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �1Spi11-Resistant Pressure Vacuum Breaker ` ' ��i� Manufacturer I/l�a+�-S Model Number LFbO`��T Size P� Located At ��czss G11�15�.�.�_ Aa- •�4'L. Serial Number 1 U' 7g��t Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �t=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 �e� � psid Held at 5� `� psid Opened at 2•o Opened at Held at Initial Test Closed Tigh� Closed Tight �. psid psid psid Leaked❑ Leakedl�l Did not open �l Did not open �I Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight�l ClosedTight❑ psid psid psid Test gauge used:Make/Model VJ�C� ��—S SN: 1(p ( o�a�j Date Tested for Accuracy: I—I�- 1 L Remarks: The above is certified to be true at the time of testing. Firm Name 'Q.v� �UL�lot�v S✓LFirm Address � Z� KGNY�rs�p� 1�.1-0.•.. !�C 7��5 Certified Tester(print) N � i Certified Tester(signatur Firm Phone# 7�f� �7�� p Cert.Tester Na �Z�l�d Date O l o �i *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 far recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: � S�S D Po. � W�5 / � ��✓� CONTACT PERSON/PHONE: LOCATION OF SERVICE: ( �� o, ..,t LU�ST ��-�� 7 S o C� 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 [lReduced Pressure Principle-Detector ❑DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer ��,d Model Number L�'E�cs'IYl 3 Size �� Located At i�.:�,�7 ��.w ��t� Serial Number �� l�b 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 Z•� Opened at Held at Initial Test Closed Tight� Closed Tight �— psid psid psid Leaked❑ Leakedf� Did not open Cl Did not open ❑ Leakedn Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tigbt❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model�'7"�`�' � SN: `l D f C��Q�J Date Tested for Accuracy: f — � �_ /,L Remarks: The above is certified to be true at the time of testing. FirmName Firm Address L ��.J� !�� 8a✓ .e.J �s 7� z-8� Certified Tester(print Certified Tester(signature Firm Phone# g4�d 3� 7 5�� Cert.Tester No.��,�3 c� Date �D—LO-��e * 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: 15�� o � ►-�� WC,S� CONTACT PERSON/PHONE: LOCATION OF SERVICE: 1 � �D �� +'� l��S 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�educed Pressure Principle ❑Reduced Pressure Principle-Detector ❑DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �il�,�t�,�j Model Number �� Size� Located At Ca�S� 12'�S�sf� �w�- Serial Number d S� �3�o Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Y�s Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve lst Check 2nd Check Held at�psid Held at�psid Opened at Z��P Opened at Held at Initial Test Closed Tightf,� Closed Tight� psid psid psid Leaked❑ Leaked❑ Did not open Cl Did not open ❑ Leakedn Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tigbt❑ Closed Tight❑ psid psid psid Test gauge used: Make/Model ��—S SN: / �a I ��} a`�} Date Tested for Accuracy: 1 – 1�- )� Remarks: The above is certified to be true at the time of testing. FirmName Icw. ��d'Icw S,/c, Firm Address Z `7G�os Certified Tester(print) ,r� (1� Certified Tester(signature) � Firm Phone# q� 3�0� `�o l� Cert.Tester No. � Z�36 Date /s ►Q /�G * 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: `S �O �y' o', � L t��S� CONTACT PERSON/PHONE: LOCATION OF SERVICE: �S o a �� t�S 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 L�educed Pressure Principle ❑Reduced Pressure Principle-Detector ❑DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer w�rlr S Model Number L�ob`31�t.. Z �T Size� 1(Z H Located At LI�S�.:�c 1�/�r,��,.;,,,� .�.(.- [.��„�r��, Serial Number O 3� 1 q�1 Is the assembly installed in accordance with manufactwer 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 ��T psid Held at �,O psid Opened at �,`t Opened at Held at Initial Test Closed Tight� Closed Tight� psid psid psid Leaked I 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 1 psid psid psid Test gauge used:Make/Model V�/� G S�—S SN: � �O f a�a`� Date Tested for Accuracy: I- /S- I� Remarks: The above is certified to be true at the time of testing. FirmName �,�IQ.i,� ca,cY�lo,, � ;C�� Firm Address Zo�Z �►.�s� I�r.. � �7�z�s Certified Tester(print) � Certified Tester(signature Firm Phone# g�C1 � 7 �/� Cert.Tester No.� z`1'30 Date /s � / * 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: / S�� o� w+ WC�'T � L,✓� CONTACT PERSON/PHONE: LOCATION OF SERVICE: / � � o� �v'� ds7 L1/� ��a<<'i 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 64�educed Pressure Principle 1Reduced Pressure Principle-Detector I�i Double Check Valve 1 Double Check-Detector [1PressureVacuumBreaker 1Spill-Resistant Pressure Vacuum Breaker Manufacturer � � 7� Model Number (.�O��Z Size � �12.� Located At L� � Serial Number �Z�'1 �a,� Is the assembly installed in accbrdance with manufacturer recommendarions and/ar 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 atl�_tJ psid Held at�•� psid Opened at 2�� Opened at Held at Initial Test Closed Tight�, Closed Tight� psid psid psid Leaked�.1 Leakedf '�, Did not open f�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��1 psid psid psid Test gauge used: Make/Model SN: � �O��'y Date Tested for Accuracy: l— ! — ,(� Remarks: The above is certified to be true at the time of testing. Firm Name��1,.��,��ci� Firm Address2Z��Z� � ��Q�7 l�� <Ca.JY�� 7—� 7G' z-`�S" Certified Tester(print) � �tified Tester(signature) � .� �� Firm Phone# �� j� � �� 7 Cert Tester No.,�� Date �D -!d�� * 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: L S�t'7 �o�e..��w� �Sa��I CONTACT PERSON/PHONE: LOCATiON OF SERVICE: �7�r� ra. h.t�65% �'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 �duced Pressure Principle � IReduced Pressure Principle-Detector � I Double Check Valve i��1 Double Check-Detector 1PressureVacuumBreaker ` ISpill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number 1-�bv�!�✓bL Size Z�� Located At�A9�T �� /� Serial Number � Z Z.l 3�'j Is the assembly installed in accordance with manufacturer recommendations andlor 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 2� psid Held atG '� psid Opened at 3• � Opened at Held at Initial Test Closed Tight� Closed Tight X1� psid psid psid Leaked�� I Leaked[:l Did not open '� I 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 Closed Tight C I psid psid psid Test gauge used: Make/Model� ��-'� SN: �, �l� L n �� j Date Tested for Accuracy: l`[ �—�,� Remarks: The above is certified to be true at the time of testing. Firm Name t�A-cr�r.� Firm Address -�� O1 � ��. �ZF�S Certified Tester(pri nt) e sJ � Certified Tester(signature) Firm Phone# �`�D 3�� fc��9 Cert.Tester No.�O a..�-!3� Date l fl-�n-I L * 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