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2016_1221 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: ��fl� I�IL't��✓' e�� P Pe�I CONTACT PERSON/PHONE: Le �` i LOCATION OF SERVICE: 1$S � ar The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY iReduced Pressure Principle -]Reduced Pressure Principle-Detector ��t.Double Check Valve 'Double Check-Detector I IPressurc;VacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Zr � Manufacturer ��C�� Model Number �� Size Located At rj_ � -i�.�c�r �•�• ��c� Serial Number � ��f� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Reduced Pressure Princi le Assembl Pressure Vacuum Breaker � Double Check Valve Assem�ly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at��psid Held at Z� ( psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight �� psid psid psid � Leaked� I Leakedl i Did not open I Did not open Leaked I Repairs/ Materials Used Held at psid Held at psid I Test After Opened at Opened at Held at Repair Closed Tight' i Closed Tight I psid psid psid I Test au e used: Make/Model �Mp� ��`Z-d�IK SN: ZS�CJ)Ua I � � I Date Tested for Accuracy: � �/� I Remarks: I The above is certified to be true at the time of testing. /� / 1 �► f/ .�J . / � � Firm Name 1...0 'e � D Firm Address `J7�.�j' (RJ(2:i �$�' L-1� � � � � � Certitied Tester(pr nr) U f� �I 1 Certified Tester(signature) Firm Phone# z��-`C7(�'-��`f"U Cert.Tester No. 0 S Date �� I *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS I **USE ONLY MANUFACTURER'S REFLACEMENT PARTS I White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION l'� 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) �p�p�fr_ 1 _ MAILING ADDRESS: I 3�� W ra n� ler �� _� � _ d�Fb CONTACT PERSON/PHONE: /1�a�r Z � � LOCATION OF SERVICE: /�S Qr �' "� 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 '-lRed�iced Pressure Principle-Detector ; I Double Check Valve Double Check-Detector I IPressurc:VacuumBreaker -�Spill-Resistant Pressure Vacuum Breaker r �� Manufacturer �Gt�tS Model Number d0� /n� � Size 2 I � � s� �` � o c��c� Located At � a'- '�'� Serial Number � manufacturer recommendations and/or local codes? `�� j Is the assembly�nstalled in accordance with Reduced Pressure Princi le Assembl Pressure Vacuum Breaker i � Double Check Valve AssemUly Relief Valve Air lnlet Check Valve I 1 st Check 2nd Checic Held at ��`� psid Held at �r1 psid Opened at Opened at Held at j I 'tial Test Closed Tightl�3 Closed Tight�'I psid psid ps�� ae,�j Leakedl I Leaked! I Did not open i Did not open ! Leaked I i Repairs/ i Materials i Used Held at psid Held at psid Test After Opened at Opened at Held at i Repair Closed Tight' i Closed Tight' I psid psid psid � ,l S D -- zl�D . Z C3 T st au e used: Make/Model Y�`hC.C� `T� �K` SN• � � i e g g Date Tested for Accuracy: g �� /�' � Remarks: The above is certified to be true at the tiine of testing. Firin Name C�upP�°jl —L�71� Firm Address (�3 �" Pr Ui^ � �� --�--. J Q �/ r I � Certified Tester(przrt) �aVi`Q I�.,��(�J Certified Tester(signature) �� Firm Phone# '- � Cert.Tester No.�l/WIv�Date �� '�� I� �/� �9� � � *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS i **USE ONLY MANUFACTURER'S REFLACEMENT PARTS � hite-Cit Co Yellow-Customer Co Pink-Tester's Co W v av pY PY IRRIGATION � DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signed and dated original a ° 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) � efl MAILING ADDRESS: 1303 (�nc� �� r CONTACT PERSON/PHONE: C..ou�S G'a�S Z�4 -4`t4 �FfO � LOCATION OF SERVICE: 1�5 ) c�rk[l�� 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 '�RedEiced Pressure Principle-Detector �4Double Check Valve iDouble Check-Detector i I Pressurc;Vacuum Breaker 'Spill-Resistant Pressure Vacuum Breaker Manufacturer r��-� Model Number � ��V Size zi / Located At��1-}� �� S G�oo� Serial Number t� � �� 3� Is the�ssembly installed in accordance with manufacturer recommendations and/or local codes? �eS � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve AssemUly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at Zr Z psid Held at Z:� psid Opened at Opened at Held at I tal Test Closed Tightry� Closed Tight �f psid psid psid �ass Leakedl I Leakedl I Did not open � Did not open Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Ciosed Tight' � Closed Tight I psid psid psid Test gauge used: Make/Model t�rn��e.� �D�Zd�TK SN. Z5�'3000 Date Tested for Accuracy: 4l��o �(o Remarks: The above is certified to be true at the time of testing. l�O 2�� i cJD r !30� WrCJ�P� I e/' �tr �1� �� II F�rm Name . P� Firm Add ess l�'e _ ru�l n � � �� Certified Tester(pr�nr)DG��'r� � �'J Certified Tester(signature) I ,/� ' ��'16�58 / Z� - l Firm Phone# ��7��1 t• ��U�U Cert.Tester No. Date Z� � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS I **USE ONLY MANUFACTURER'S REFLACEMENT PARTS � White-City Copy Yellow-Customer Copy Pink-Tester's Copy j IRRIGATION DOMESTIC FIRELINE � The following form must be completed for each assembly tested. A signeci 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: � 3 0� W�c�'er �--i� �p p p��r CONTACT PERSON/PHONE:Lo u i�5 IYlac-�a5 / - y�� --$0�f� LOCATION OF SERVICE: I f S" � ar [c�u.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 ` iReduced Pressure Principle -1Reduced Pressure Principle-Detector �4Double Check Valve Double Check-Detector ' I Pressur�Vacuum Breaker -,Spill-Resistant Pressure Vacuum Breaker �� Manufacturer �'eb�o Model Number � 5�� Size Z Located At ` i en ft i s C� en�-�✓ Serial Number � 3�}�"75 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �eS � 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 Z�`} psid Opened at Opened at Held at Initial Test Closed Tightl`i° Closed Tight �� psid psid psid PaSS Leakedi I Leaked! i Did not open I Did not open ! Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight ; ClosedTight I psid psid psid Test gauge used: Make/Model �-c�a'''��j�c.r� �{(�-Z��(L SN: �ZSS4CJ�(� Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. FinnName�p�� -�-5� Firm Address �� Q� � �'�/ � ,, r Certified Tester(pr�r:t) c o�l E Certified Tester(signaiure) Finn Phone# Z�T��-1 � "��`tV Cert.TesterNo.� O �S Date �Z Z� �� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT 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: / U` 3 I � �r� �0 �� CONTACT PERSON/PHONE: L�u�5 � ' S Z/�f ��{ � -�n�d LOCATION OF SERVICE: 1 " � CtrlLw The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certi6ed to be operating within acceptable parameters. TYPE OF ASSEMBLY IReduced Pressure Principle '-�Reduced Pressure Principle-Detector ��DoubleCheck Valve ",Double Checic-Detector IPressur�VacuumBreaker lSpi11-Resistant Pressure Vacuum Breaker � ,z,� Manufacturer �eb CO Model Number �S'� � Size Located At N.U�a;t 5�" C�r �l,c lt�' / u rroDs�- Serial Number `7" D�9�9 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? T �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 Z�� psid Held at Z�Z psid Opened at Opened at Held at Initial Test Closed Tight!!�P Closed Tight�4 psid psid psid Pp.55 Leaked I Leakedl I Did not open I Did not open ! Leaked ' Repai rs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight' i ClosedTight I psid psid psid Test gauge used: Make/Model M rac.-n �b ` Z�� f (� SN: ��O�U Date Tested for Accuracy: � � Remarks: The above is certified to be true at the time of testing. Firm Name �� V' Firm Address �3 03 UU�'� �t�Y �-t�Y. � Certitied Tester(pr�nr) ((� � I Certified Tester(signature) � Firm Phone# Z��'�`� l � D� Cert.Tester N o. fJ PQ Qp��o Date � �! z"�l�� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION �C DOMESTIC FIRELfNE � The following form must be completed for each assembly tested. A signed and dated original must be submitted to the public water supplier for recordlceeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) � � MAILING ADDRESS: � �3 � ra►1 �er ��r e� � CONTACT PERSON/PHONE: Z�4 �4 q e-rd o4� Ln c��S c�,�s LOCATION OF SERVICE: t$S arlcwa`I 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 ;!Red�iced Pressure Principle-Detector � I Double Check Valve I Double Check-Detector ! IPressurc;VacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker �L 7 � Manufacturer l��f�s Model Number �� Q � Size z i Located At��@.YIi�A 1' `U`�� ' Serial Number C��(o'�( ��1 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? y�S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker � Double Check Valve AssemUly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at �� psid Held at�,y psid Opened at Opened at Held at Initial Test Closed Tight�`K' Closed Tight ! I psid psid psid �Q[J�j Leakedl I Leaked! I Did not open i Did not open ! Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight ! Ciosed Tight. I psid psid psid Test gauge used: Make/Model�M�'�'�-�-v �v'� �� - SN: ��g0� Date Tested for Accuracy: [ r��/� �- Remarks: The above is certified to be true at the time of testing. r j ` ` e// Firin Name��1 ��.� Firm Address � 8� GlJ/t�l't (i�' i r � J , � '' � Certitied Tester(prant) Q!?f�Gi �Lf f/ Certified Tester(signature) � �Q/� Firm Phone#�� "g�� Cert.Tester No. ItJI"D��7�� Date �� '�'� /�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC � FIRELINE � The fol(owing 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� r1 CONTACT PERSON/PHONE: L o u i 2/ — �-� 'v LOCATION OF SERVICE: I � � rlWa The backflow prevention assembly detailed below has been teste and inaintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY iReduced Pressure Principle ]Reduced Pressure Principle-Detector � IDoubleCheckValve !DoubleCheck-Detector ' I Pressur�Vacuum Breaker -!Spill-Resistant Pressure Vacuum Breaker l �i Manufacturer I�J�( Ie l Yl S Model Number �1 S Size �� (�7— Located At �'� �es� 1�12-Z� Serial Number L �� I 7� 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 I st Check 2nd Check Held at�psid Held at psid Opened at �' � Opened at Held at Im al Test Closed Tight� I Closed Tight i 1 psid psid psid �a5� Leaked� I Leaked i Did not open I Did not open ' Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight' i Closed Tight I psid psid psid Test gauge used: Make/Model�..0 M U21Lt3 ��- ZG��SN: 2-��QO� Date Tested for Accuracy: 9� ��P//(p Remarks: The above is certified to be true at the time of testing. / .- / '�, �p -��J FirmName��Upl,°�` J—J� Firm Address 13�� ( e� �'� � � ��'�P� � Certit7ed Tester(pr�nr) ��►'�j�t_Certified Tester(signature) � Firm Phone# Z — ��Q 7� Cert.Tester No. POOD�7� Date � �� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC � FIRELfNE � 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: 1�03 �,t�rc� �►�' 'r � G�� CONTACT PERSON/PHONE: I' �Gt zl '45l�`"$f�4b LOCATION OF SERVICE: �' r a 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 � IDoubleCheckValve ' !DoubleCheck-Detector I IPressur�VacuumBreaker iSpill-Resistant Pressure Vacuum Breaker �j,j_ ,��r Manufacturer ��, `� Model Number �� M � Q"� Size Located At �tA'�� 1�Y'D�3`3:� �• /Gk- Serial Number �(�b Is the assembly installed in accordance with manufacturer recommendations and/or local codes? eS Reduced Pressure Princi le Assembl Pressure Vacuum Breaker � Double Check Valve Assembly Relief Valve Air lnlet Check Valve 1 st Check 2nd Check Held at ��3 psid Held at ��psid Opened at Opened at Hetd at Initial Test Closed Tight' i Closed Tight i 1 psid psid psid �olSS Leakedl I Leaked' i Did not open . i Did not open ' Leaked , Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held�t Repai►• Closed Tight' , Closed Tight ! psid psid psid Test gauge used: Make/Model �/)'1�rGtC-D '7Q'�'�� SN: �-�� Date Tested for Accuracy: '7�1�P Remarks: The above is certified to be true at the time of testing. Firm Name � �� `�s Firm Address �03 �/�n� (QY �� Certified Tester(pr�nt) � , Certified Tester(signature) � Firm Phone#2��( ��`t� Cert.Tester No�� Date s�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT 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: ��JO�S ��`a►'LG'� e�r' ��P�� CONTACT PERSON/PHONE: o i5 Mt�c,�uS z I�! -�E�ilo -�p�D LOCATION OF SERVICE: IS� � Q��(�'�""� The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable paraineters. TYPE OF ASSEMBLY !Reduced Pressure Principle '-IRed�iced Pressure Principle-Detector +�PDouble Check Valve !Double Check-Detector I1PressureVacuumBreaker ',Spill-Resistant Pressure Vacuum Breaker 1 ��i Manufacturer �/Qt� Model Number ��7/n� Q i Size Located At ft/ r`«" �5� Serial Number ��a� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ve5 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 2�d psid Held at �� psid Opened at Opened at Held at [ ' ial Test Closed Tight' I Closed Tight I I psid psid ps�� ass Leakedl I Leaked� I Did not open , 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 psid psid Test gauge used: Make/Model�M�C.v ��M Z� �� SN: Z�� Date Tested for Accuracy: l�/fQ �� Remarks: The above is certified to be true at the time of testing. n 7 FirmName �-OP��I� '�SD Firm Address t �3 f � / � � � ! � Certified Tester(pr�r�t)� Uo ' - t� Certified Tester(signature) Firm Phone# ��`I"�(O C�l/`�� Cert.Tester No. kJ�� Date �r ��" * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT 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) /7� I' MAILING ADDRESS: 0` � rc� � ��r CONTACT PERSON/PHONE: �aS 4-� � "��`�� LOCATiON OF SERVICE: � 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 paraineters. TYPE OF ASSEMBLY ` IReduced Pressure Principle ':iReduced Pressure Principle-Detector yolDouble Check Valve 'Double Checl<-Detector 'IPressureVacuumBreaker ':Spill-Resistant Pressure Vacuum Breaker r� Manufacturer W 0.'�'�g Model Number f�0"� - m'� QT Size 2 Located At ✓i�1�e� S't"Qait�lY� Serial Number Tt Q �-7 (� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? vE'S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker � Double Check Valve Assembiy Relief Valve Air lnlet Check Valve 1 st Check 2nd Checic Held at �0 psid Held at 1�� psid Opened at Opened at Held at Initial Test Closed Tight' i Closed Tight � I psid psid ps�� Leakedl I Leaked! I Did not open I Did not open ! Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight' i Closed Tight� I psid psid psid Test gauge used: Make/Model `�'�'��raCO �0 �2 4� � SN: ��d� Date Tested for Accuracy: ��/� /�o Remarks: The above is certified to be true at the time of testing. Firin Name l A'++'�Q�� -��-5� Firm Address f�0� l�� 8� �}r 2 , � � Certified Tester(pi-�nt) U i� 1-�� Certified Tester(signature) � • Firm Phone# ��'��1�v'�� Cert.Tester No.$P�7� Date � �� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT 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: I 30'� � �I I CONTACT PERSON/PHONE: LouiS A Zj4 -�{ (e,•-`�64fj LOCATION OF SERVICE: �'1� w The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable paraineters. TYPE OF ASSEMBLY : iReduced Pressure Principle '^:Redticed Pressure Principle-Detector ,�dDouble Check Valve Double Check-Detector ` I Pressure Vacuum Breaker i Spill-Resistant Pressure Vacuum Breaker L � Manufacturer (�4T S Model Number�'�"7 m( Q 1 Size Zr Located At `�^e 11,(�1 � E.'a1T2r Serial Number ��(flSfo Is the assembly installed in accordance with manufacturer recommendations and/or local codes? e�__ 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 ��7 psid Held at I,`� psid Opened at Opened at Held at Initial Test Closed Tighti I Closed Tight I I psid psid psid �a� Leaked� I Leaked! i Did not open I Did not open ' Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight'�� i Ciosed Tight� I psid psid psid Test gauge used: Make/Model �f'tiDhaC.C� �� •- �0 � SN: L�5&b0� Date Tested for Accuracy: g /�o �l� Remarks: The above is certified to be true at the time of testing. ��`I 1 , �� Finn Name � $� Firm Address �� W� t� /✓ � Certified Tester(prtnr)�U i ��Certified Tester(signature) � Firm Phone# ��`t —"T l�'~�b� Cert.Tester No�� Date ��12� �l� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy � _ — IRRIGATION DOMESTIC x 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 recordl<eeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) i � el 1 MAILING ADDRESS: 1303 G�rAn If.✓ CONTACT PERSON/PHONE: L.o��S � Zl ` q6-�e�� LOCATION OF SERVICE: I�1S'� - � � v 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 �QDoubleCheckValve ' ':Double Check-Detector 1 Pressure Vacuum Breaker 'Spill-Resistant Pressure Vacuum Breaker I � � ii Manufacturer GVA��S Model Number ��7�� _Size Located At fto�'rIe `�J�2��tin N,/� Serial Number f-t �U�oS� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve AssemUly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at �� ' psid Held at Z�� psid Opened at Opened at Held at I ' ial Test Closed Tight i Closed Tight i I psid psid psid QC�� Leaked! I Leaked� '� Did not open ! Did not open ! Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight ; ClosedTight I psid psid psid Test gauge used: Make/Model �I►1�►'d�C� ��' �� %u SN: Z�� Date Tested for Accurac : � ��0 1� I Y Remarks: The above is certified to be true at the time of testing. i Firm Name � 'I �-S� Firm Address �3�� ' �� (� � � Certitied Tester(pr�nt) � f�,1( Certified Tester(signature) i Firm Phone# Zf�- `t 1 �P��`7V Cert.Tester NaI71"�� Date � �� ` I � TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS I **USE ONLY MANUFACTURER'S REFLACEMENT PARTS I White-City Copy Yellow- Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC k 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 recordl<eeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) n MAILING ADDRESS: I �3 (�raV�sl�!' 1.�� (�P�,I CONTACTPERSON/PHONE: u�s Z��F' ��6-So�o LOCATION OF SERVICE: S � r o. 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 '.-IRed�iced Pressure Principle-Detector i IDoubleCheckValve 'Double Check-Detector I IPressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker ,Z�r Manufacturer � Model Number�p47/'n� �I Size Located At��Om��1'Ct�iUn'l �/CK Serial Number ��(psS Is the assembly installed in accordance with manufacturer recommendations and/or local codes? 7eS � Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Hetd at�Z psid Held at �. / psid Opened at Opened at Held at Initial Test Closed Tight( i Closed Tight i I psid psid psid a55 Leakedl I Leakedl ; Did not open � Did not open I Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight' i ClosedTight� I psid psid psid Test gauge used: Make/Model l.;pmt7lrZC0 `t'D��1� SN: ��3d�U Date Tested for Accuracy: 9 f/!o�llo Remarks: The above is certified to be true at the time of testing. Firm Name �DD�� -j-SD Firm Address l�� w�'n 'l�°Y 1.--�)Y � er/ .. � 9 Certitied Testcr(prinr) �a Uf� � Certified Tester(signature) Firm Phone# `1"- `�a 70 Cert.Tester No. / DOQ��s� Date �' �� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy