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Prologis Park-LR170111IRRIGATION 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,,1 CONTACT PERSON/PHONE: LOCATION OF SERVICE: I u 1-1 Cu-Wy uA �Z H�� � )c, I 1,iT>c 7-z-- tc8'y-C; zSZ .of— 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 El RS ced Pressure Principle -Detector []Double Check Valve e5ouble Check -Detector []Pressure Vacuum Breaker 11 Spill -Resistant Pressure Vacuum Breaker Manufacturer Lj c I �1 ^I Model Number������� �-+� Size Located Ati ag I� Sw cotv%*_.-* J/'oNiA-y Serial Number Is the assembly installed in accordance with manufacturer recommendations and/or local codes? c-.jL Test gauge used: Make/Model W , ` SN: 0 f ( 1 6 9 tS Date Tested for Accuracy: &, CD ' L 16 Remarks: The above is certified to be true at the time of testing. Firm Namel',xil0&4j"' Firm Address '"60kX38 Certified Tester (print) tr— vQ & Certified Tester (signature) Mle)C.C3, ►oI�^ Firm Phone # Cert. Tester No. �Piq-�5Date /—I * 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 Reduced Pressure Principle Assembly Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at LAf psid Held at/. (V psid Opened at Opened at Held at Initial Test Closed Tight Closed Tight psid psid psid Leaked❑ Leaked[]Did not open F1Did not open F1Leaked[]Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight El Closed Tight1-1psid psid psid Test gauge used: Make/Model W , ` SN: 0 f ( 1 6 9 tS Date Tested for Accuracy: &, CD ' L 16 Remarks: The above is certified to be true at the time of testing. Firm Namel',xil0&4j"' Firm Address '"60kX38 Certified Tester (print) tr— vQ & Certified Tester (signature) Mle)C.C3, ►oI�^ Firm Phone # Cert. Tester No. �Piq-�5Date /—I * 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 v 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: Pro Los S 'L. Q I /j Mu,,wwuol 'h-2.YS-a 13cd1-_tT�d 7 T -LQ ( CONTACT PERSON/PHONE: 7 'Z - r 8' - 9 Z 9 Z LOCATION OF SERVICE: 41(.5 AJ I--Pc-e a jr- - twy 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 ❑DoubleCheckValve P�ouble Check -Detector ❑ Pressure VacuumBreaker ❑Spill -Resistant Pressure Vacuum Breaker Manufacturer LJ c I,$ Model Number 7> 0 X <-b Size 3/y Located ANQti �� Ge.^ i u%,jr, c.,, Serial Number �{ 2 �� 2- (� CA( Is the assembly installed in accordance with manufacturer recommendations and/or local codes?y e S Test gauge used: Make/Model W41(11^ SN: dl 1 % c (713 Date Tested for Accuracy: 6-(o - / Remarks: The above is certified to be true at the time of testing. Firm Name AD4L4 to &04<T&/ Firm Address P(% int k 3lilM 0,7 Certified Tester (print) Y [ (�K MeO 0AW Certified Tester (signature) e. a - d Firm Phone # � 14---- yo -D& Cert. Tester No. 6 PJIxS * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS Date 1-t/-/'7 White- City Copy Yellow- Customer Copy Pink- Tester's Copy Reduced Pressure Principle Assembly Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at/. 3 psid Held at /• 7 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 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 W41(11^ SN: dl 1 % c (713 Date Tested for Accuracy: 6-(o - / Remarks: The above is certified to be true at the time of testing. Firm Name AD4L4 to &04<T&/ Firm Address P(% int k 3lilM 0,7 Certified Tester (print) Y [ (�K MeO 0AW Certified Tester (signature) e. a - d Firm Phone # � 14---- yo -D& Cert. Tester No. 6 PJIxS * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS Date 1-t/-/'7 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/'u4"AS tj WQ&^wu 0d b—ZY,'- t1 pe. ( Iar7�y7S Z, CONTACT PERSON/PHONE: -7 2 If 9 2 LOCATION OF SERVICE: 9_/5 /\% �_ fC `� 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 ❑DoubleCheckValve ?6o"uble Check -Detector ❑ Pressure Vacuum Breaker 11 Spill -Resistant Pressure Vacuum Breaker Manufacturer W .' )G1Model Number -S -5 J !TS rQAize V Located AtM&A L03 carH e✓ 03, ,pood7Serial Number Ct 3 13 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? y .t Test gauge used: Make/Model SN: d 1 t l 699 Date Tested for Accuracy: Remarks: 6,10 —/ 16P The above is certified to be true at the time of testing. Firm Name V Ud Address � &X 31313 7 T j Z-/ 3,00 Certified Tester (print) l °( 20 v�CrB Certified Tester (signature) �c. Firm Phone #d,14410 1 -4774, Cert. Tester No. ft4;�( Date * 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 Reduced Pressure Principle Assembly Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check -^d Held atpsi Held ata psid Opened at Opened at Held at Initial Test Closed Tighit Closed Tight Npolfpsid psid psid Leaked[] Leaked[] Did not open ❑ Did not open ❑ Leaked[] Repairs/ Materials Used Test After Held at psid Held at psid Opened at Opened at Held at Repair Closed Tight ❑ Closed Tight ❑ psid psid psid Test gauge used: Make/Model SN: d 1 t l 699 Date Tested for Accuracy: Remarks: 6,10 —/ 16P The above is certified to be true at the time of testing. Firm Name V Ud Address � &X 31313 7 T j Z-/ 3,00 Certified Tester (print) l °( 20 v�CrB Certified Tester (signature) �c. Firm Phone #d,14410 1 -4774, Cert. Tester No. ft4;�( Date * 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 V"', 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: Pro f ,�Q 13 14ct a L,a cj a d'ZYSQ 7) ZQ CONTACT PERSON/PHONE: 417 L — & r y - 9 9 ?— LOCATION OF SERVICE: F r e.Q Jv,,r- —11 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 Double Check Valve Ctlo�uble Check -Detector ❑PressureVacuumBreaker ❑Spill -Resistant Pressure Vacuum Breaker Manufacturer 1c j yo, Model Number -S :5'0 At SIVAr Size $' c O., j�e.? /�Gj--.,- Located At \ %4A C t... �-e a)1' 614!% Serial Number :o % y r3 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ,V t � Test gauge used: Make/Model IV i-rS .-1-K r? -( E�, SN: (g Date Tested for Accuracy: G — (o —f The above is certified to be true at the time of testing. Firm Name V0.1/1 °(�Qli� °( .1-tPJ irm Address `PV &K Sia R 7 DOROO �UyI��{s, %�C 6130 < Certified Tester (print)(A Certified Tester (signature) �` t.���Zcar..��✓ Firm Phone # 40 I -4%7Cert. Tester No. CJ PS S�(o 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 Reduced Pressure Principle Assembly Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd 2nd Check Held at, O psi Held at ! • 5, 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 Used Test After Repair Held at psid Closed Tight ❑ Held at psid Closed Tight ❑ Opened at psid Opened at psid Held at psid Test gauge used: Make/Model IV i-rS .-1-K r? -( E�, SN: (g Date Tested for Accuracy: G — (o —f The above is certified to be true at the time of testing. Firm Name V0.1/1 °(�Qli� °( .1-tPJ irm Address `PV &K Sia R 7 DOROO �UyI��{s, %�C 6130 < Certified Tester (print)(A Certified Tester (signature) �` t.���Zcar..��✓ Firm Phone # 40 I -4%7Cert. Tester No. CJ PS S�(o 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