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RPZ_2016_1228 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) 1 MAILING ADDRESS: �v03 r `r ��i CONTACTPERSON/PHONE: �� ' �S z� ��'�� D O LOCATION OF SERVICE: C�S`� lJ� 4r G��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 ,4Reduced Pressure Principle ';!Reduced Pressure Principle-Detector � IDoubleCheckValve 'Double Check-Detector !1 Pressure Vacuum Breaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer�f5 Model Number �Q / � Size � �� Located At �. !�/e-Z-Z— Serial Number J��?�2/ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? 7�5 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' i Closed Tight I I psid psid psid a�j�j Leakedi I Leakedl I 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' i Closed Tight� I psid psid psid Test gauge used: Make/Model �+'n 1'J�v ��Z��'� SN: Z��d� Date Tested for Accuracy: =/ _�C/I�� Remarks: The above is certified to be true at the time of testing. @� � e�l Firm Name ' - e 1 �S.0 Firm Address Q3 � �� Certitied Tester(pr�nt) A.l)�ul tJQ1 Certified Tester(signature) F Firm Phone# �� t�"'��v Cert.Tester No.�� Date ��!2�/�� * 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 recordlceeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) � 1 ` MAILING ADDRESS: � �� W �' �'''r � '�� CONTACT PERSON/PHONE: LD i � LOCATION OF SERVICE: ($�� " c�►'k-�-=""'t The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �RReduced Pressure Principle '.-IReduced Pressure Principle-Detector � IDoubleCheckValve ' 1Double Check-Detector i 1Pressur�VacuumBreaker �Spi11-Resistant Pressure Vacuum Breaker Manufacturer �a�� Niodel Number �� Size 3� Located At W�'S� �eZZ �I(:�L— Serial Number �nZ-� d�v Is the assembly installed in accordance with manufacturer recommendations and/or local codes?"��S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker � Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Checic Held at ��Z psid Held at psid Opened at�,(� Opened at Held at ' ial Test Closed Tight'�� Closed Tight '�1 psid psid ps�� a,s�7 Leakedl I Leaked� i Did not open ! Did not open ! Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight I I ClosedTight I psid psid psid Test gauge used: Make/Model l��rac� `f 0 A Z� ��— SN: ZS�da� Date Tested for Accuracy: e1 I�/�� Remarks: The above is certified to be true at the time of testing. FirmName � � t �D Firm Address �� `�� r � �� (� � � � Certitied Tester(pr�nt)�(�Uid I�b•�Certified Tester(signature) Firm Phone# 2��1— `t� 10 �D� Cert.Tester No.1�..�I W�(p�s� Date � Z� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC � FIRELINE � The following form must be completed for each assembly tested. A signed and dated original ` must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) + MAILING ADDRESS: ��iO3 'u��av� l2r �� -P�� CONTACT PERSON/PHONE: Lou� �� Z°�`�`��—�4� LOCATION OF SERV ICE: l$S"- l►J a►'kW�`-f 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 �teduced Pressure Principle 'iRed�iced Pressure Principle-Detector ; IDoubleCheckValve ,Double Check-Detector , IPressur�VacuumBreaker -',Spill-Resistant Pressure Vacuum Breaker 3�� Manufacturer �Q�S Model Number oe� r� - 3 Size Located At �2S'� �ZZ �J I UL Serial Number 2��{'�l� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? e 5 Reduced Pressure Princi le Assembl Pressure Vacuum Breaker � Double Check Valve AssemUly Relief Valve Air Inlet Check Valve 1 st Check 2nd Checic Held at �,D psid Held at psid Opened at Z�`� Opeued at Held at [nitial Test Closed Tight' i Closed Tight � I psid psid ps�� PaS�j Leakedl I Leakedl 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' i ClosedTight I ps�d psid psid Test gauge used: Make/Model��,nvrAC n �O'" u�T1L SN: ZSgG� Date Tested for Accuracy: �'I lo l� Remarks: The above is certified to be true at the time of testing. Firm Name I I �S� Firm Address ��4� � �a . �I �� \ � ' Certified Tester(pr�nt)��}.v iA I,L�Certified Tester(signature) Firm Phone# ZI�} —��1'��8��"f� Cert.Tester No.IJp.�Q��Sg 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 recordlceeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: { �3 �r��'�- ✓ �� e�� CONTACT PERSON/PHONE: � C 2�4 - �7(0 -- 0 U LOCATION OF SERVICE: Sr � 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 +�Reduced Pressure Principle -!Red�iced Pressure Principle-Detector � IDoubleCheckValve ` �Double Check-Detector ' IPressurcVacuumBreaker iSpi11-Resistant Pressure Vacuum Breaker i� Manufacturer �(.�' Model Number LC(��9� s�ze r�z- Located At '�i�-�hE.✓1 I c� M��►'� �or� Serial Number � � �" �� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �-`� Reduced Pressure Princi le Assembl Pressure Vacuum Breaker � '1 Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Checic Held at �,Zpsid Held at �psid Opened at 'Z=� Opened at Held at Initial Test Closed Tight i Closed Tight � I psid psid ps�� ae� Leakedl I Leaked' t 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 I ClosedTighti I psid psid psid Test gauge used: Make/Model��M��-L� l 0�� SN: 2S�SQ�� Date Tested for Accuracy: ��/fo ��O Remarks: The above is certified to be true at the time of testing. [/ ��Y r ss �-� �l.l /?��l� ��' ��</ Firm Name � Firm Add e ` � � w � Certitied Tester(pr�nt)_�J(,�Jl t ('�(� Certified Tester(signature) Finn Phone#2�`�"'`TI� �� 7�' Cert.Tester No. 1 tifN��'-�U 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) f 1 ��( MAILING ADDRESS: 130� W c`a �'i' � CONTACT PERSON/PHONE: ` �� ' �� -" � U LOCATION OF SERVICE: I� '� � F'c�r' � The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within accepeable paraineters. TYPE OF ASSEMBLY �educed Pressure Principle '-;Red�iced Pressure Principle-Detector � IDoubleCheckValve 'Double Check-Detector f IPressurcVacuumBreaker �Spill-Resistant Pressure Vacuuin Breaker �r Manufacturer�(�'� Model Number �Q�J 1'1� � (�'� Size ��`Z Located At ��C� �� he ��'�� Serial Number � � S�oZ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ��5 � 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_�psid Opened at �•Q Opened at Held at Initial Test Closed Tight' i Closed Tight I I psid psid psid Pa� Leaked' I Leakedl 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 �►�(-U Td"� 2� �K SN: �-S �d�� Date Tested for Accuracy: I f Remarks: The above is certified to be true at the time of testing. � , \ � � �� Fir�n Name��p e� ( -�-- � Firm Address ��3 W C' �✓� --,-, � r � °I � Certified Tester(prirt) U� I.�bt t Certified Tester(signature) � Firm Phone# � ��"7 /b r�Z� Cert.Tester No. �'�'��g Date �a� 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: I 30 � � �a�q I� �;r' �o pp�(� CONTACT PERSON/PHONE:Lo � �a5 215� ��7� a D LOCATION OF SERVICE: 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 �iReduced Pressure Principle '-iRed�iced Pressure Principle-Detector � IDoubleCheck Valve ',Double Check-Detector !1PressurcVacuumBreaker ',Spill-Resistant Pressure Vacuum Breaker Manufacturer U�.I��S Model Number L�00� (�f Size ��'Z� Located At �—5�t ot2� Serial Number ��1 �(3 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �GS � 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 psid Opened at Z.<<o Opened at Held at Initial Test Closed Tight'. i Closed Tight � I psid psid psid �cj Leaked! I Leakedl 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� Z�� L SN: ZS gOQ� Date Tested for Accuracy: �l f� /�i Remarks: The above is certified to be true at the time of testing. Firm Name ��Pe�l �s�_Firm Address � ��3 W ra�f/��' �i� � �/ l � \ r ` Certified Tester(prinr) U/�G1 k.AI I Certified Tester(signature) Firm Phone# Z��.'�� 1 b'�Q�� Cert.Tester Na�PDOO�7SS Date �1�� * 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: ��3 W �� CONTACT PERSON/PHONE: ui S �ct 2�"-� -4 � " O�Fd LOCATION OF SERVICE: C 8� (,�� arkwa`1 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 �2educed Pressure Principle ':?Red�iced Pressure Principle-Detector �1Double Check Valve !Double Check-Detector 'IPressureVacuumBreaker lSpi11-Resistant Pressure Vacuum Breaker Manufacturer W i'I K►�l"►5 Model Number 37S XL Size ��2 Located At (�pf1C�?S� c 0 I'� �IY�R110. Serial Number�� y'�� o� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? et 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 Zi I psid Held at psid Opened at .3.� Opened at Held at Initial Test Closed Tightf i Closed Tight '� I Ps�d ps�d US�� QS� Leaked! I Leaked', � 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 ClosedTight' I ClosedTight' I ps�d psid psid Test gauge used: Make/Model �D�'►'1Df'a �o �D' �'��'�SN: ��Jl��d Q Date Tested for Accuracy: ��f� ��! Remarks: The above is certified to be true at the time of testing. ` � �� l�Jra ��' l,i'� (___E� �`� Firm Name��1 / -1-sD Firm Address ` � . i � Certified Tester(prinr) Cf I/r� �/ �Certified Tester(signature) — � Firm Phone# �� 7" "I 7 ��d��d Cert.Tester No. ��P 0 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 recordlceeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: ( 30'3 ��OL��'�-�' ��r �P�� CONTACT PERSON/PHONE: L.ou i S M-acia�s z�`� `'-�a�v '" g�'`�'o LOCATION OF SERVICE: (�(5 C..� ' (�rl�ir�'1 The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable para�neters. TYPE OF ASSEMBLY `�educed Pressure Principle '.-!Red�iced Pressure Principle-Detector � iDoubleCheckValve 'Double Checic-Detector ' IPressurcVacuumBreaker 'Spill-Resistant Pressure Vacuum Breaker I 1 3�� Manufacturer �'��`i5 Model Number 1 �� Size Located At I�1 t�L'Q Yl O. �1-i�r� r i ser (bDi'►'�► Serial Number ��0 4�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e 5 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 psid Opened at �.'� Opened at Held at [ ' ial Test Closed Tightf i Closed Tight � I psid psid ps��1 �a�jj Leaked! I Leakedl 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 ClosedTight' i ClosedTight I psid psid psid Test gauge used: Make/Model `O+'''� �r0`�� d`� ��SN: zs�bC� Date Tested for Accuracy: R ��O �� Remarks: The above is certified to be true at the time of testing. � Firm Address i 3 a3 (sJ�v�G I� L--�r � ��t Firin Name L..vDA�� -F—�� P �-• , ' � � � Certified Tester(pr=nr) O�U� C'. Certified Tester(signature) Firm Phone# Z��"�� "��a Cert.Tester No.k.�l ��0�5(:.`� Date l� 2g 1� * 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