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2016_1028 IRRIGATION DOMESTIC FIRELWE � 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: �_ — .� 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 ❑R�duced Pressure Principle-Detector ❑Double Check Valve �'Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer_ �,/c,��'�-5 Model Number 7 7� n � `� 1L___(1�h Size�_ Located AtZ� Vr, S ,,' � G S ' �f r31�� Serial Number��q Is the 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 psid Held at psid Opened at Opened at Held at Initial Test Closed Tight❑ Closed Tight ❑ psid psid psid Leaked❑ LeakedL� 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 C� psid psid psid Test gauge used:Make/Model�� ,r- q!� SN: n�,�� Date Tested for Accuracy: �-C-� 1 Remarks:�c�� ,�'F- -�-j- /a �p�4 ri e� r�A.��LP.ci,. The above is certified to be true at the time of testing. FirmName�•re,�-Z;��Sc,� ,q.,,,�r•��FirmAddress�,�� v �-u�pss ��,i�l Certified Tester(print) �[,t.� T�`oS Certified Tester(signatwe) � Firm Phone# �/7�- ��.�{-- �(��r� Cert.TesterNo.�� j��r{ Date_ .l b ��-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 IRRIGATION DOMEST�C 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) Ma1LnvG aDD�ss: 01 ✓�nu 'f� ��4 CONTACT PERSON/PHONE: = • l � 7-�/f- $ 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 ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �,✓c,i -��-G Model Number__ ��n�( Size �{�,. Located At y�� , 5;'a�, �,� f3��r,,�}� 1�0 Serial Number�� ,y(,7 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 Opened at Held at Initial Test Closed TightL� Closed Tight � psid psid psid Leaked❑ Leaked� Did not open �J Did not open ❑ LeakedCl Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight C7 psid sid p psid Test gauge used:Make/Model/�r,,�_�r��c._�li-� SN:p 3 0:5 c�]-�-3 Date Tested for Accuracy: �6�I[� Remarks: The above is certified to be true at the time of testing. Firm Name,G're.�- L;�� s��e-�-_��-,��r;cuFirm Address �. �.I-w, r u f�s� i"�1✓� Certified Tester(print) G Kc ��bS Certified Tester(signature) Firm Phone# r-17 d-- }..��F� c��,� Cert.Tester No.13(��c�l ��-6�f Date l,� '�g�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 LD. #0570040 (Customer) MAILING ADDRESS: /�(r �� ,� • ' �p CONTACT PERSON/PHONE:�z�h �- � ��.�,7—cr�&S LOCATION OF SERVICE:3a I S � /1/or�, ,-�,h�` n/ -� 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 C�ouble Check Valve ❑Double Check-Detector �PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer l,/a�"�,s Model Number !JD`J,v`� Size �--�i Located At�r�v� {�c��l'��I riG��' � S•`ae q� 13�Serial Number i 7��'1-O 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 Opened at Held at Initial Test Closed Tigbt� Closed Tight I� psid psid psid LeakedJ Leakedf i Did not open I I 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❑ psid sid p psid Test gauge used:Make/Model /�G�,�{r�"��,o �� SN:� �Sp�R�...�.� Date Tested for Accuracy: �f-/'�-f(, Remarks: The above is certified to be true at the time of testing. Firm Name�ir��L�,�� .Firm Address�� l„�, LN�es S �"�l✓d. � Certified Tester(print) fi�c- ' Certified Tester(signature) � Firm Phone# �1��--�}../h— 9��gq Cert.Tester No.B��,� 3�b�. Date (0 -�'l(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) MAILING ADDRESS: p 12 0 ✓ 't C�,'� CONTACT PERSON/PHONE:1= � 7— 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 �ubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �,./c�-W'S Model Number�n7n� t Size ��„ Located At�/civ►/�' /!�� C'�('/!cr n� �� Serial Number ��a 5�-6 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 Opened at Held at Initial Test Closed Tight❑ Closed Tight L 1 psid psid psid Leaked� 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❑ psid psid psid Test gauge used:Make/Model,/1/1 rr�� r�Gt�r✓ ��S SN: �3n 50�-�-3 Date Tested for Accuracy: ��—(�—I�� Remarks: The above is certified to be true at the time of testing. Firm Name�"r�^�"Z;��/�'n�r',`CuFirm A ddress =r,� _ j✓ Certified Tester(print) T,`�S Certified Tester(signature) Firm Phone# �/7�--� ��l'— �/3g0 Cert.TesterNo.I�n��)�,.��v( Date �Q'��b * 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: p� CONTACT PERSON/PHONE:,�=/,-�.,� �.,�L� �-(�-- 7-�/3ge LOCATION OF SERVICE:�O 1 .S . /�/�r,�'l1 n�J,"✓I-�' �r 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 ❑Rfe�uced Pressure Principle-Detector ❑DoubleCheckValve C�ouble Check-Detector �Pressure VacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer L,lcA�`�'S Model Number 7 J�� 'Jl�(�A' Size �� Located At �/o��►/.� NG c_c�n� c�� rW n Serial Number�n p�(�G( 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 Opened at Held at Initial Test Closed Tight❑ Closed Tight ❑ psid psid psid Leaked�1 Leaked'�� Did not open Cl Did not open n Leaked'J Repairs/ Materials 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/Model/�ila��r��.f.r' ��S SN: ��OSC)�-� Date Tested for Accuracy: �jF-(�(� Remarks: �v�.c,�6,�t� �� i�` hc�� VQ.c��.�i< �ae/��,r��c,��jt� The above is certified to be true at the time of testing. FirmName�'rrz}-L,,Fc_ Cr�e,�y •�,��,'��irm Address 1v Certified Tester(print) V' �`� Certified Tester(signature) Firm Phone#q 7.1- �-�-�-�!3�,O Cert.Tester No.13 nc�c�l 3 J-6 K Date ' �'( * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-Ciry 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: ��-�� CONTACT PERSON/PHONE:��,2� �..I�' 7�— CJ�S�S S LOCATION OF SERVICE: �3 p I S. /,/a/�.�� `n-� �� 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 ❑Reduced Pressure Principle-Detectar �oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �7Spi11-Resistant Pressure Vacuum Breaker Manufacturer t,�/Q•I�� Model Number nn7�,� Size � `/�-�� Located At n/,� _tfd�� h� �.6�r�� . ti�1�2 �,�X Serial Number (�s'�,$`� 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 Opened at Held at Initial Test Closed Tight[�l/ Closed Tight C� psid psid psid Leakedl 1 Leakedl-� 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 ClosedTight❑ ClosedTight n psid psid psid Testgaugeused: Make/Model��r�"�iu✓ �'�FS SN: D3a5�.�.,l.e� Date Tested for Accuracy: ��G -'�6 Remarks: The above is certified to be true at the time of testing. FirmName��-L,� �«�� m�r,��cFirm Address � W, = � ° Certified Tester rint I�•�r �'rJ> Certified Tester si ature � ) � � ) Firm Phone#�'�'�}.�4- �13p�0 Cert.TesterNo. 13f�e+�l 3�6�1 Date (n �2d `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