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2016_0922 IRRIGATION � DOMESTIC F�RELIfVE The following form must be campleted for each assernbly 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: CONTACT PERSON/PHONE: � .-e ��. -361� 6 L� L�CATION OF SERVICE: z l , The backflow prevention assembly detailed below has been tested and maintained as reyuired by commission regulations and is certified to be operating within acceptabie parameters. TYPE OF ASSEMBLY :Reduced Pressure Principle ';lReduced Pressure Princi�le-Detector �DoubleCheckValve 'Double Check-Detector -'PressureVacuumBreaker Spi11-Resistant Pressure Vacuum Breaker Manufacturer � _Model Number �ta7y�j Size � Located At Serial Number_/�5' �'z-� Is th�assembly installed in accordance with manufacturer recorrunendations and/or local codes? Reduced Pressure Princi le Assemhl Pressure Vacuum Breaker Double Check Valve Assembly Relief Vaive Air Inlet Check Valve I st Check 2nd Check Held at � •� psid Held at �:� psid Opened at Opened at Held at Initial Test Closeci Tight� Closed Tight � psid psid psid Leaked I Leaked' ' Did not operi Did not open ' Leaked ' Repairs/ Materials a Used Held at psid Held at psid Test After 'Opened at Opened at Held at Repair Closed Tight � Closed Tight psid psid psid ' Test gauge used: MakelModel �/�r•-, �f.�s' SN: d7d q"�� Date Tested for Accuraey: b-g�P-6 ` Remarks: ` The�above_is cer�ified to be true�at the time of testing. � Firm Name �[�� - ��wuS Firm Address 'Pc��-� ��"j ��„ � �]�/�'� Certified Tester(print)�,,,�,��Certified Tester(signature) _ �� Firm Phone# �a�� .fs'�- 't�-�`� Cert.Tester No. jj�� 6 f-S��7 Date q� �'_�.-� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Cust�mer C�opy Fink-Tester's Capy IRRIGATtON DOMESTIC � F�RELINf The following form must be completed fbr each assembly tested. A signed ana dated original must be submitted to the public water supplier for recordlceeping purposes: � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 � (Customer) ' MAILING ADDRESS: CONTACT PERSON/PHONE: �'Yd f / 572,��6 �l 6'�f'ro LOCATION QF SERVICE: � �.I S �LayoiQ_ The backflow prevention assembIy 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 L�oubleCheckValve 'Double Check-Detector -'PressureVacuumBreaker : 'Spill-Resistant Pressure Vacuum Breaker Manufacturer �it�i/�a Model Number az'7�c1 Size � Located At �� Mt��, Serial Number /�? �,�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? -�2r✓ Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Gheck D Held at � psid Held at�' � psid Opened at Opened at_ Held at Initial Test Closed Tight�! Closed Tight''� psid psid psid Leaked ' Leaked .! id not open 1 Did not open ' l Leaked. ' Repairs/ Materials a Used � Held at psid Hetd at psid Test After 'Opened at_ Opened ai Hetd at__ Repair Closed Tight'.i Closed Tight'i ' psid psid psid ' Test gauge used: MakelModel !�/��- ��C SN:_b?►� 9�� Date Tested for Accuracy: �-`/'-/,� ` Remarks: The ab�ve is certified to be true at the time of testing. FirmName ��i'S�_ �Firm Address �� '�? J��7�`/68 Certified Tester(print)�,��o��C'ertified Tester(si�mature)_ � Firm �'hone# - 2'�—??r? T_Cert.Tester Nc�.�� v �� 7 Uate �J �"�� * 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 tRR(GATION � DOMESTIC FIRELINE The following form must be completed for each assembly tested. A signed and dated original must be submitted to the pz�blic water supplier for recordkeeping purposes: � BACKFLOW PREVENTiON ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 � (Customer) ' MRILING ADDRESS: C1�N'I'ACT PERSON/PHONE: � �)� (�'7� LOCA'I'ION OF SERVICE: ,G The baekflow prevention assembly detaiied befow 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 -�Reduced Pressure Principle-Detector �ouble Check Valve 'Double Check-Detector -'PressureVacuumBreaker Spii1-Resistant Pressure Vacuum Breaker IVlanufacturer ��CR� Model Number �.�� Size � Located At /�� Serial Number C��'g 1?� Is the assembly instal4ed 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�' � ps' Held at + J psid Opened at Opened at Held at Initial Test Closed Tight[ � Closed Tight ' psid psid psid Leaked � Leaked! Did not open I Did not open '. Leaked '. Repairs/ Materials a Used Held at psid Held at psid _ Test After 'Opened at_ Opened at Held at Repair ClosedTi�ht'��.i ClosedTight�-i psid psid psid ' Test gauge used: Make/Model /,�� SN: U ?cJ��'t��L� - Date Tested for Accuracy: �- �'- /6 ` Remarks: The above is certified to be true at the time of testing. � Firm Name�� ,rR �crv.3' Firm Address �'a�r—,� �� G.��-�nc �S'>�� --�— Certified Tester(print) �� Certified Tester(signature) �� Firm Phone#�i�v •�� _?-z S`? Cert.Tester No.��-,� L�f,s`� Date ��Z'Z—�-�►�, * 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 F{RELINE �� 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. #0574040 "� (Customer) � � MAILI�IG ADDRESS: CONTACT PERSON/PHONE: Z- �/� �S�d LOCATION OF SERVICE: S The backflow prevention assembly detailed belaw 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 'Reduced Pressure Principle-Detector �%"ISouble Check Valve 'Double Check-Detector -iPressureVacuumBreaker Spi11-Resistant Pressure Vacuum Breaker Manufacturer ��-,� Model Number �a� Size 3�" Lacated At /I��, �� Serial Number � 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 r� psid Held at�� B psid Opened at Opened at Held at Initial Test Closed Tight'.� Closed Tight "� psid psid psid Leaked: ' Leaked, ; Did not open ' Did not open '' Leaked ! Repairs/ Materials s Used Held at psid Held at_ psid Test After •Opened at Opened at Held at Repair Closed Tight i' Closed Tight'; I p��d psid psid � Test gauge used: Make/Model �/��. ��S SN: o?v`�v y---�'� Date Tested for Accuracy: �-2 I- �� ` Remarks: The above is certified to be true at the time of testing. Firm Name �v��.e�. �jsg �-yvS Firm Address Po�'��7 {�c/ac.�L, �. 7,�'t�a' Certified Tester(print)�,�,o�L�,��Certified Tester(signature) �� -�� Firm Phone# C��-__��- 2� Cert.Tester No.��'P��/.�"`� Date_ � Z'�_��' * TEST RECORDS MUST BE KEPT FOR AT LEA5T THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATI�N DOMESTIC FIRELINE ✓ The following form must be com�leted for each assembly tested. A signed and dated original � must be submitted to the public water supplier for recordlceeping purposes: BACKFLUW PREVENTION ASSEMBLY TEST Ai�iD MAINTENANCE REPORT NAME OF PWS: CITY OF CUPPELL PWS I.D. #057Q040 " (Customer) � M�►ILING ADnRESS: CONTACT PERSON/PHONE: ��, �'�2�3 � 'as� LOCATION OF SERVICE: r �1 S. �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 �?'bouble Check-Detector -'PressureVacuumBreaker :'Spili-Resistant Pressure Vacuum Breaker Manufacturer Model Number �C�� Sizc � Located At /(J,E , �� Serial Number A1✓�- '3�� _ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum 8reaker Doubie Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check �7 Held at 3 ��d Held at �� psid Opened at Opened at Held at Initial Test Closed Tight Closed Tight�-�' psid psid psid Leaked;i Leaked.�l Did not open l Did not open I Leaked ' Repairs/ Materials � Used ' Held at psid Field at psid Test After -Opened at Opened at Held at Repair ClosedTight':I ClosedTi�ht`.::', psid psid psid � Test gauge used: Make/Model f�,,�,Q,�,,._, '7��S SN: G�'7 v9a+-}a'd� Date Tested for Accuracy: �� /�, ' Remarks: The above is certified to be true at the time of testing. Firm Name �c-�...�� ia�e Y'-'3' Firm Address Po�T_-7 q7 f/��/C� Certified Tester(print)�� Certified Tester(signature) _ ��-� Firm Phone#�'A�-�"v - '�-d'-7 Cert.Tester No._�_Q ryvv��? Date__�v-�_ *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEA.RS **USE ONLY MANtJFACTURER'S REPLACEMENT PARTS White- City Copy Ye11ow-Custom�r Copy Pink-Tester's Copy IRRIGATION D�MESTIC FIRELINE ✓ The following form rnust 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: CONTACT PERSON/PHONE: �� ?�- (� (a��''� LOCATION OF SERVICE: ��! 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 iReduced Pressure Principle _'Reduced Pressure Principle-Detector �Doubte Cheek�Jalve 'Double Check-Detector -;PressureVacuumBreaker ' �Spill-Resistant Pressure Vacuum Breaker Manufacturer ModeI Number�be Size '� Located At /(�m,�'�,� r�� Serial Number ��7i 1s the assembl}�instalted 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�•v psid Opened at Opened at Held at Initial Test C3osed Tight� Closed Tight� psid psid psid Leaked I Leaked'.! id not ope❑ ' Did not open ' Leaked ' Repairs/ Materials s Used Held at psid Held at__psid Test After •Opened at Opened at Held at Repair Closed Tight'::� Closed Tight ', psid psid psid � Test gauge used: Make/Model Gt�,��+,,.,. ��'-�' SN: U7�'9��A� Date Tested for Accuracy: 6' ��!� ' Remarks: The above is certified to be true at the time�of testing. � Firm Name��_ �� c�v� Firm A ddress� ��'j�7 C�c�.,C,- � 7S�'16� � Certified Tester(print),��_ l�.-�� Certified Tester(signature) Firm Phone#�-5.�0 - �� Cert.Tester I'�o.�p�__�a/S Date ��z'��' * TEST RECORDS MUST BE KEPT FOR AT LEAST THR�E YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATI�N D�MESTIC FIRELINE � The following form must be comp[eted 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 FWS: CITY OF COPPELL PWS I.D. #0570040 f (Customer) � ' MAILING ADDRESS: CONTACT PERSON/PHONE: lST LOCATION OF SERV ICE: 2, 1 b 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 pararneters. 'I'YPE OF ASSEMBLY �]Reduced Pressure Principle tReduced Pressure Principle-Detector :Double Check Valve ✓"�ouble Check-Detector ';�;Pressure Vacuum Breaker ` 'Spill-Resistant Pressure Vacuum Breaker Manufacturer__1�� Model Number -�L � Size_�_ Located At ,/v, •�rf4 �.t,�Q�� Serial Nuinber �� `� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Presswe Princi te Assembl Pressure Vacuum Breaker Double Check Valve Assembly Rzlief Valve Air Inlet Check Valve 1 st Check 2nd Check �,2 Held at3•a psi Held at psid Opened at_ Opened at Held at Initial Test Closed Tight�� Closed Tight ii� psid psid psid � Leaked�1 Leaked'�I Did not open �l Did not open ��! Leaked�� '; Repairs/ Materials s Used � Held at psid Held at psid Test After •Opened at Opened at Held at Repair Closed Tight!_1 Closed Tight'_ I psid psid psid - Test gauge used: Make/Model �-�/�`�.-r�-� � �' SN: dI�U`��a' Date Tested for Accuracy: ln-�-1� ' Remarks: The above is certified to be true at the time of testing. Firm Name ��,�,�...o i'�. �w� Firm Address pv�=79'7 �it/a�,�ic 7,S'/(� Certified Tester(print)�.i,,�,�e�, � Certified Tester(signature) �.-.,� ��^� Firm Phone# a'L�—5`,�- ��'� Cert.Tester No. �� o,z--(,/,�'h Date__9-Z�_�_ *TEST RECORDS MUST BE KEPT�OR AT LEAST THR�E YEARS ** USE ONLY P�IANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy