The URL can be used to link to this page

2016_1028 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: ,/ o CONTACT PERSON/PHONE: � � — _ LOCATION OF SERVICE: � t— 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 • ❑Re uced Pressure Principle ❑Reduced Pressure Principle-Detector ouble Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker i�Spill-Resistant Pressure Vacuum Breaker Manufacturer_�„/o�t��s Model Number�07.� I Size �� Located At�j� �nrne✓�� ron �' ,�.��fer �3 ox Serial Number I G n]��f. 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 TightC� Closed Tight I� 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�J ps�d psid psid Test gauge used:Make/Model�d�,�r��,� g�c5 SN:�345pd-�� Date Tested for Accuracy: �}—G— 16 Remarks: The above is certified to be true at the time of testing. FirmName�rt�' �.i�t,Sa'F n� r+,'c Firm Address�11 �,,/, )�u j�� Iv�, Certified Tester(print) d.,u� Certified Tester(signature) Firm Phone#cf 7,��.�y."4j�o Cert.Tester No.)3Pvo l�1(.�y Date�� - 2q—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 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 LD. #0570040 (Customer) MAILING ADDRESS: ,s CONTACT PERSON/PHONE:J�'J,•�r,� << I�� 7— ��F$ S LOCATION OF SERVICE: OO .$.��n�'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 ❑Re ced Pressure Principle ❑Reduced Pressure Principle-Detector oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �/�s Model Number �((J],�,�Z Size �� ,r,p�Fe� Located At�.% (.,►n,-.�g r a� �2/Z'��YSerial Number�n C,�� 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❑ Leaked❑ Did not open ❑ Did not open n Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ ClosedTight❑ psid psid psid Test gauge used:Make/Model/1/)aG/�r{��,� �;� SN:�j050 �� Date Tested for Accuracy: �-�-I G Remarks: The above is certified to be true at the time of testing. Firm Name�tg ��,'�� S��t� /�Mer+�c_�c Firm Address - I � CertifiedTester rint O.u(` �� CertifiedTester si nature � ) � � g ) Firm Phone#q7..,t.- �-.le�-q 3�{J Cert.Tester No.!3 Poo I 31-(,C( Date �� -�.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) MAILINGADDRESS: �Qd/ ��5 �✓e..�uc�_� Sc.c,'��_ �.�n0 CONTACT PERSON/PHONE:�j,�z�r �f`L �—I'�— �-G�— fJ��S LOCATION OF SERVICE:�Q� a/�;�,no;'h-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 ❑Re uced Pressure Principle ,-]Reduced Pressure Principle-Detector oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker �� Manufacturer �,.iot�'�S ModelNumber Jp7.v`l Size� Located At NC �1'�n t�►� i� nn zfe r (�o,l� Serial Number o4-�I��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 l st Check 2nd Check Held at��psid Held at J , b psid Opened at Opened at Held at Inirial Test Closed TightL� Closed Tight I� psid psid psid LeakedC� Leaked❑ Did not open ❑ Did not open J Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight Cl ClosedTight❑ psid psid psid Test gauge used:Make/Model�a��y��`r�..� �,5 SN: O?,��S 0�,3 Date Tested for Accuracy: ��1�7 Remarks: The above is certified to be true at the time of testing. FirmName��.j- L�`�C� 5�trc�Y ,�1{�e✓';CaF'irm Address��.1 W� ��.r��s,� 'l��✓� Certified Tester(print) << � Certified Tester(signature) Firm Phone#_y7�—�-r�.,�f--S�,j�O Cert.TesterNo.(3�p�;��t Date (Q-�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 I.D. #0570040 (Customer) MAILING ADDRESS:o� CONTACT PERSON/PHONE: ` — — O 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 C�ouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer ��I Model Number ��(-, Size `�_ Located At/1�� .orr,g.� o� (�io� ,:� ✓au/�Y Serial Number F(II.S�� i)�1� Is the assembly installed in accordance with manufacturer 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�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid Leaked❑ Leaked❑ Did not open n 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/�G,,f+,Q�t`h«/ ��'S SN:��050�3 Date Tested for Accuracy: 1f—(,—1(� Remarks: The above is certified to be true at the time of testing. FirmName�re �- �,��'t Sa� An�P�r'rc�Firm AddressZR�.I �./. Lu��.s_� f31✓�l_ Certified Tester(print) < <'O5 Certified Tester(signature) � Firm Phone# �7�-'dZ�'�'9'3B D Cert.Tester No.L3Pna/3�.,G� Date 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 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: - - -�� 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 ❑R�duced Pressure Principle �Reduced Pressure Principle-Detector C�oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer�� Model Number �0_5�1� Size 3� Located At�/J= C�.O✓'nP_i' ��"Oron Z.L ✓�.r,c/� Serial Number05 J�1$I 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 Tigbt � psid psid psid Leaked-1 Leaked❑ Did not open ❑ Did not open ❑ Leaked�l 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��,��r7�u�' ��s SN: lI,3 O�SO �.a-� Date Tested for Accuracy: �-�-J G Remarks: The above is certified to be true at the time of testing. Firm Name�'re.�'L��C� .SU��y �M t r��KFirm A ddress�R�1 l,/, l��le ss �31✓d Certified Tester(print) IA r (`OS Certified Tester(signature) Firm Phone# �'7�- �-�.4 - �.3�n Cert.TesterNo.C3�1��13��1 Date � e2g'��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