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2016_1014 IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A sigr►ed and ciated original must be submitted to the public water supplier for recordkeeging purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: CONTACT PERSON/PHONE: ,� /7- 3-?/- ,(7�i� LOCATION OF SERVICE: _ I//D F�t.e�.u�_ The backflow prevention assembly detailed below has been tested and maintained as required by cammission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ' ;Reduced Pressure Principle '_7 Reduced Pressure Principle-Detector i-]Doubie Check Valve �uble Check-Detector -i Pressure Vacuum Breaker -�:Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number ''�09 p�GG�� Size o Located At S� �-�� Serial Number //.3�.5�� Is the assernbly 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 Iniet Check Valve 1 st Check 2nd Check 3 � 2, � Held at � psid Held at psid Opened at Opened at Held at � Initial Test Closed Tighti�.✓ Closed Tight � psid psid psid Leaked f � LeakedC l id not open :; Did not open i 1 Leaked'. I Repairs/ Materials s Used Test After Held at__psid Held at psid -Opened at Opened at Held at Repair Clased Tight L� Closed Tight�=i psid psid psid Test gauge used: Make/Model /��g �� 'S- SN: G►'7O 9py��'� Date Tested for Accuracy: �-9-// ` Remarks: The above is certified to be true at the time of testing. Firm Name H ' �� -,�/a'� Firm Address�v�� "7T7 ��7�t 7Sib�' Certified Tester(print)�.,r•.c�K�. �Certified Tester(signatare) �r"�- Firm Phone# �o'°-S'SO' 7-'�� Cert.Tester Ncf�f� c�oa �/S � Date /O-f�f-/� *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 comp(eted for each assembly tested. A signed and ciated ariginat must be submitted to the public water supplier for recordkeeping purpvses: BACKFLOW PRE VENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570440 (Customer) MAILING ADDRESS: CONTACT PERSON/PH�NE: � rx,�,,�w4 f 7' ?�/- ��1� LOCATION OF SERVICE: _ //[iJ Go�.e� The backflaw prevention assembly detailed below has been tested and maintained as required by commission regulaqons and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ;Reduced Pressure Principle _�Reduced Pressure Principle-Detector �oubleCheckValve ''Double Check-Detector �iPressureVacuumBreaker �'�Spiil-Resistant Pressure Vacuum Breaker Manufacturer Gtl� Modei Number Oo��t Size �l� Located At �� I�/� Serial Number �� Is the assembly installed in accordance with manufacturer recommendations andJor local codes? v Reduced Pressure Frinci 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/� psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight� psid psid psid Leakedi i LeakedCi Did not open `.i Did not open � I Leakedl 's Repairs/ Materials s Used Held at psid Held at psid Test After -Opened at Opened at Held at Repair Closed T'rght__� Ciosed Tight:-1 psid psid psid Test gauge used: MakefModel t.(/��j��s �� "� SN: p7D 9p�� Date Tested for Accuracy: �-9-f� ' Remarks: The above is certified to be true at the time of testing. FirmName� ��2 �Firm Address �v�,� '?�Tl �_�� Sib� Certified Tester rint �, Certified Tester si ature � (P ) � �� ( � )_ Firm Phone# �a'°-S'SO' Z��7 Cert.Tester Nc�P c��a 6/S � Date /O—f�-/G * TEST RECORDS MUST BE ICEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIREUNE �/ 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: CONTACT PERSON/PHONE: r� re. �,,,�„r,4 �7- 3�/- .(��s�9 LOCATION OFSERVICE: f�/v �eL�rc The backflow preventioa assembly detailed beiow 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 '._:iReduced Pressure Principle-Detector i.iDoubLeCheckValve v''bouble Check-Detector �7PressureVacuumBreaker i-�:Spi11-Resistant Pressure Vacuum Breaker p/i Manufacturer � Model Number �� Size Located At •� - �� Serial Number f/�6 02 Is the assembly inst�tlled in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Do�ble Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at �� psi Held at Z'�psid Opened at Opened at Held at Initial Test Closed Tight� , Closed Tight �� psid psid psid Leaked�i Leaked;��i Did not open �.! Did not open i I Leaked'�; � Repairs/ Materials s Used Held at psid Held at psid Test After -Opened at Opened at He1d at Repair Closed Tight:._! Closed Tight C; psid psid psid Test gauge used: Make/Model G,c/j��/s �� "S SN: p?'�904��'�_ Date Tested for Accuracy: �'9-/� ` Remarks: The above is certified to be true at the time of testing. FirmName fl� ��..2 �Firm Address �v�,�-,� "7l7 �,��1_ 7Si.6�' Certified Tester rint N Certified Tester si ature � (P )��— ( � ) `�� Firm Phone# ��-S'SO' �'�� Cert.Tester Ncf�� vaa �/S �Date /L��1�-/� * 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: CONTACT PERSON/PHONE: v � _�,��w4 �7- 37/- ,I�� LOCATION OF SERVICE: ///O �yc.e�.��„� � 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 1�SoubleCheckValve C�Double Gheck-Detector �7PressureVacuumBreaker ��Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number �o'fi y�t Size� Located At /V � i�� Serial Number Zq��`� Is the assernbly 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 � '� psid Held at �'6 psid Opened at Opened at Held at Initial Test Closed Tight'�� Closed Tight� psid psid psid Leakedi�i Leaked�i Did not ope❑ ..i Did not open i�} Leaked; s Repairs/ Materials � Used Held at psid Held at psid Test After -Opened at Opened at Held at Repair Closed Tight�� Closed Tight Ci psid psid psid Test gauge used:Make/Model J�(/�/��s �� "� SN: O?�90��'�_ Date Tested for Accuracy: ��9-�/ ` Remarks: The above is certified to be true at the time of testing. FirmName_� �,�.� �Firm Address�v�� ?"77 �a.,�C,'T�_ �SibcP Certified Tester(print) ,,�h.�.�� Certified Tester(signature) ��'� Firm Phone# ��-SSO' �-1�7 Cert.Tester Nd�p vda �/S � Date /O—/�-/� *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 �Y DOMfSTIC FfRELINE The fotlowing 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 PRE VENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: CONTACT PERSON/PHONE: v �► � �,,,.,,.,.4 /7- ?-�/- /�9aL9 LOCATION OF SERVICE:�//O E"�t �cv�.�i,.� ~` The backflaw prevention assembly detailed below has been tested and maintained as required by commission regularions and is certifed to be operating within acceptable parameters. TYPE OF ASSEMBLY ' ',Reduced Pressure Principle :i Reduced Pressure Principle-Detector �oubleCheckValve `"'Double Check-Detector ��PressureVacuumBreaker -'Spill-Resistant Pressure Vacuum Breaker r p �� Manufacturer r�--6 c.�, Model Number a d 5� � Size Z Located At �ic.G�� -�(s_ � J7� Serial Number � Is the assernbly 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 tJ y Held at �' psid Held at Z� psid Opened at Opened at Held at Initial Test Closed Tightl� Closed Tight �t✓ psid psid psid Leaked( '', LeakedLi Did not open ' Did not open '� i Leaked' '�. Repairs/ Materials s 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/Motiel /�[/�/��s �� '� SN: p7D 904��_ Date Tested for Accwacy: �-9-f� ' Remarks: The above is certified to be true at the time of testing. FirmName fit'�t.�.,-:, ��.2 �Firm Address �v�,E�,� "7''�7'7 �l. �5�.6� .,��-T Certified Tester(piint)��r.�� ,Q,� Certified Tester(signature)_ _ �� Firm Phone# ��-S'S"O' ��'�7 Cert.Tester Nd,�p voa �/S � Date /O—/�-/� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Gustomer Copy Pink-Tester's Copy IRRIGATION DOMESTIC V FIRELlNE The following form must be completed for each assembly tested. A signed and dated originat 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: CONTACTPERSON/PHONE: v � � �,,�,,.�.4 !7- ��/- /��1r�9 LOCATION OF SERVICE: III (� F,c��V�t � �- � `-`- The backflow prevention assemb}y detailed below has been tested and maintained as required by commission regularions and is certified to be operating within acceptable parameters, TYPE OF ASSEMBLY ::�Reduced Pressure Principle `.iReduced Pressure Principle-Detector �oubleCheckValve -;Double Check-.Detector r]Pressure Vacuum Breaker -':Spill-Resistant Pressure Vacuum Breaker Manufacturer L�� Model Number OD 7�'�t l Size � Located At �� -�� Serial Number ,f�l..s��"-�� Is fhe assembly installed in accordance with manufacturer recommendations and/or local codes? i 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 �� psic! Opened at Opened at Held at Initial Test Closed Tighti� Closed Tight � psid psid psid Leakedf 1 Leakeclrl id not open ', i Did not open ' l Leakedi ,' Repairs/ Materials s Used Held at psid Held at psid Test After -Opened at Opened at Held at Repair Closed Tight l i Ciosed Tight[ i psid psid psid Test gauge used:Make/Model /,[J,��/z �� 'S- SN: p70 90��'� Date Tested for Accuracy: ��9-// ' Remarks: The above is certified to be true at the time of testing. Firm Name ,fi� �-�f��?!� Firm Address�e�,�,� "7l7 l�i�.�_T� �Si.6� Certified Tester(prfnt)�H.•�c'fiG� � Certified Tester(sigr►ature) �tt4.� Firm Phone# �o'°-S'SO' 7-�� Cert.Tester Nd�p v�D �/S � Date /O-/�-/� *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 Gopy