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2016_1014 IRRIGATION DOMEST►C FIREL�NE � The foltowing form must be completed for each assembly tested. A signed and ciated 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: ,� �,�. 1 - - LOCATION OF SERVICE: o The backflow prevention assembly detailed below has been tested and maintained as required by commission regularions and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C�Reduced Pressure Principle [7Reduced Pressure Principle-Detector 'DoubleCheckVatve ►✓'�ouble Check-Detector '�7PressureVacuumBreaker _Spill-Resistant Pressure Vacuum Breaker Manufacturer a,� Model Number C�p�U .17 Size d Located At_�� ,,� ��7f' Serial Number ��'��a 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 Vaive 1 st Check 2nd Check -3 �1 2, 6 Held at � psid Held at psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight4=1�� psid psid psid Leaked�.��l Leaked:�l id not open _1 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:�J psid psid psid Test gauge used: Make/Model (��5 �� '� SN: p?'O 9p�� Date Tested for Accuracy: �-q-/l ' Remarks: The above is certified to be true at the time of testing. Firm Name fyCi(,�„z. �+�.2 �Firm Address �_ `,��,t� �i""T/ /�! a.,[,'T�. 7Si.6a' Certified Tester(pri�►t)�,�r.c� Certified Tester(sigr►ature) /�.�"�" �s"`yt"' FirmPhone# ��'-�'$'O� �''—�7 Cert.TesterNd,�f� v�n �lS �Date /O-14�-/G * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC FIRELINE_� The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: CONTAGT PERSON/PHONE: �a, ,�,, / - - LOCATION OF SERVICE: o b� The backflaw prevention assemb}y detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY C"Reduced Pressure Principle r'�Reduced Pressure Principle-Detector �ouble Check Valve �"Double Check-Detector �iPressureVacuumBreaker -Spi1l-Resistant Pressure Vacuum Breaker Manufacturer 1K—e.r•.a.., Model Number �a(c� Size �/� Located At /✓�� .,r �� Serial Number j��J3 Is the assembly installed in accordance with manufacturer recommendations andlor local codes? �--� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at �� psid Held at / �ps' Opened at Opened at Held at Initial Test Closed Tight� Closed Tight ' : psid psid psid Leaked'i � Leakedl 1 Did not open i Did not open _ ; Leaked+ ! Repairs/ Materials s iJsed Held at psid Held at psid Test After -0pened at Opened at Held at Repair Closed Tight: ; Closed Tight'^i psid psid psid Test gauge used: Make/Model l.c./��/g__�� "S SN: p7o 90��'�_ Date Tested for Accuracy: �-9-/� ' Remarks: The above is certified to be true at the time of testing. Firm Name� ��.2 �i�!!�" Firm Address�v`��_�'"T7 �ie,�T4l. 7Si.6� Certi6ed Tester(print),,�.�,•��-�o„Ka.r Certified Tester(signature) ��-."`r"" '-'" /� " Firm Phone# ��'-S$'O' Z1p� Cert.Tester No'�P vma �/S '� Date /O�f Lf-/� * 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 DOMEST►C FIRELINE ✓ The following form must be completed for each assembly tested. A signed and dated ariginal 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: � � / - LOCATION OF SERVICE: �, ' The backflaw prevention assembty detailed below has been tested and maintained as required by commission regularions and is certified to be operating within acceptable parameters, TYPE OF ASSEMBLY "_iReduced Pressure Principle ',�Reduced Pressure Principle-Detector F=3DoubleCheokValve w''bouble Check-Detector ,..:_,PressureVacuumBreaker �1Spi11-Resistant Pressure Vacuum Breaker Manufacturer �°`��' Model Number / `�� d/c�� Size � Located At -� � �� V �� Serial Number �l��3 Is the assembly installed in accordance with manufacturer recommendations andJor local codes? —e� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Walve l st Check 2nd Check � Held at �°psid Held at '� psi Opened at Opened at Held at Initial Test Closed Tight!� Closed Tight � psid psid psid Leaked' ', Leaked':�7 id 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 CI Closed Tight C i psid psid psid Test gauge used: Make/Model /,t/��r/�� 'S SN: p�o 90�� Date Tested for Accuracy: ��9-/t ` Remarks: T'he above is certified to be true at the time of testing. Firm Name f�l �� -�Firm Address �v�,�,E "7!7 �,��e,��. �7Sib� Certified Tester(print)�H.•-c� �s✓ Certified Tester(signature) ,�E��..,.��Y"'�^' Firm Phone# ��'°-SSO' �-�� Cert.Tester Ncf�P �p� 6/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 DOMEST�C FIRELtNE ✓ 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 PERSONJPHONE: � w � - - LOCATION OF SERVICE: � �v� The backflow prevention assembty 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 Presswe Principle �Reduced Pressure Principle-Detector u%tboubleCheck Valve iDouble Check-Detector C-iPressureVacuumBreaker -':Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number O��Y�j Size '3�� Located At S' £� �"'"'"'� �� Serial Number �`�`� �3 Is the assembly installed in accord�ance with manufacturer recommendations andJor 1oca1 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 �' 6 �ps' Held at�� psid Opened at Opened at Held at Initial Test Closed Tight�'� Closed Tight� psid psid psid Leaked'. i Leakedi 1 id not open '[ i Did not open ' '; Leaked ! Repairs/ Materials s Used Held at psid Held at psid Test After -Opened at Opened at Held at Repair Clased Tight�� Closed Tight i=i psid psid psid Test gauge used: Make/Model��s ��"S SN: 0�'D 90� �_ Date Tested for Accuracy: ��9-,[�.-� ' Remarks: The above is certified to be true at the time of testing. Firm Name�� .2 �Ia�' Firm Address �v� `7l7 a-,L,741, �Si.b� Certified Tester(print)�N r�-�'►G� �r Certified Tester(signature) , `� Firm Phone# �o'°-SSO' �� Cert.Tester Nd,�p c�oo �/S � Date /O-f�-/G *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yeliow-Cusromer 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 p�irposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: CONTACT PERSON/PHONE: fl � w � - - LOCATION OF SERVICE: 0 � d�.rf The backflaw 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 �DoubleCheckValve -'Double Check-Detector '�7PressureVacuumBreaker -Spill-Resistant Pressure Vacuurn Breaker w�� >> Manufacturer Model Number b-v?�' Size Located At N,-E- ��.� � �� Serial Number .�6°�� Is the assembiy 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 �� p�si " Held at ��psid -Opened at Opened at Held at Initial Test Closed Tight�X Closed Tight � psid psid psid Leaked� i LeakedCl � id not open l Did not open �i Leaked� i Repairs/ Materials = 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 /.�/j�j�� "S SN: O�D 90�� Date Tested for Accuracy: _��9-,[f.� ' Remarks: The above is certified to be true at the time of testing. FirmName H� �� l�r' Firm Address �v`,�,t �77 �,��•��. 7Sib8 Certified Tester(print) .� � � Certified Tester(signature) `� �'�'�— Firm Phone# ��-SS4'�-�'�'�� Cert.Tester No'�f� v�o �,/S � Date /O—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 IRRIGATION L/ DOMESTIC FIRELlNE The following form must be completed for each assembly tested. A signed and dated originai 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: CONTACT PERSON/PHONE: v n�. w / - - LOCATION OF SERVICE: �,,, 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 i�ouble Check Valve ":Double Check-Detector �-iPressureVacuumBreaker -Spi11-Resistant Pressure Vacuum Breaker Manufacturer ��/�� Model Number ��°�,8 Size Z�r Located At �� Serial Number_ L�..e.�,a.o�� Is the assembly installed in accordanee with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relicf Vaive Air lnlet Check Valve 1 st Check 2nd Check Held at �'�psid Held at2' �psid Opened at Opened at Held at Initial Test Closed Tight�!� Closed Tight t�.✓ psid psid psid Leaked:1 Leaked':1 id not open �1 Did not open ' Leaked l 'r Repairs/ Materials s U sed Held at psid Held at psid Test After -Opened at Opened at Held at Repair Closed Tight._-� Closed Tight C i psid psid psid Test gauge used: Make/Model GC/��_�� 'S^ SN: p��90� �_ Date Tested for Accuracy: ��9-// ` Remarks: The above is certified to be true at the time of testing. Firm Name H� ��.2 �Firm Address �v�,�,t ��'T7 ��_��l �Si.bB Certified Tester(print)�h r•c� � Certified Tester(signature) ,�-�h"'� �— Firm Phone# ��'-S'SO' �� Cert.Tester No'�/� c��a 6/S �Date /O-/�-/� *TEST RECORDS MUST BE KEPT FOR AT LEAST TI-IREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy