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2017_0118IRRIGATION 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/PI LOCATION OF SERVI 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 Double Check ValveDouble Check -Detector Pressurc Vacuum Breaker Spill -Resistant Pressure Vacuum Breaker Manufacturer Model Number. 7 7 Size tiat'Located At 0 �J ber I * 7 C Is the assembly installed in accordance with manufacturer recommendations and/or local codes? Test gauge used: Make/Model W 11 &1(\5 T(in S SN: O Lo / 17 7 y Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. Firm Name �� J_ Firm Address P\er_7 Certified Tester (print) tJl OCrtified Tester (signature) Firm Phone # 1 µ3� �!o Cert. Tester No. OO 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 �(p�A Held at psid 'Held *-- psid Opened at Opened at Held at Initial est Closed Tigh * Closed Tight psid psid psid Leaked' ff Leaked Did not open Did not open Leaked Repairs/ ials Used Held a psid Held at � psid Test After Opened at Opened at Held at Repairf Closed Tight Closed Tight psid psid psid Test gauge used: Make/Model W 11 &1(\5 T(in S SN: O Lo / 17 7 y Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. Firm Name �� J_ Firm Address P\er_7 Certified Tester (print) tJl OCrtified Tester (signature) Firm Phone # 1 µ3� �!o Cert. Tester No. OO 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 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. (Customer) S D o 5 o 0 �� Co MAILING ADDRESS: CONTACT PERSON/PHONE: c i •i h O fe-1 LOCATION OF SERVICE: g an $ o U� #0570040 e.il ra. e - 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 Double Check Valve Double Check -Detector Pressure Vacuum Breaker Spill -Resistant Pressure Vacuum Breaker Manufacturer W ocS Model Number L pD% rV%,3 Size_ Located At % A) Serial Number r)2__74t23 Is the assembly installed in accordance with manufacturer recommendations and/or local codes?_ Test gauge used: Make/Model w A t lin $ 765 SN: Date Tested for Accuracy: 34 16 T - Remarks: The above is certified to be true at the time of testing. n Firm Name M I `'� Firm Address (a0 G S �� K�• 54.YO) 0_t1erj_ry Certified Tester (print) �� 2f �Okr+S°nCertified Tester (signature) Firm Phone # "b 17-371 _p X56 Cert. Tester No. f � O I. Date � 17 * 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 t • n psid Held at.2 a psid Opened at Opened at Held at Initial Test Closed Tight* Closed Tight`K psid psid psid PLeaked 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 _ i Closed Tight psid psid psid Test gauge used: Make/Model w A t lin $ 765 SN: Date Tested for Accuracy: 34 16 T - Remarks: The above is certified to be true at the time of testing. n Firm Name M I `'� Firm Address (a0 G S �� K�• 54.YO) 0_t1erj_ry Certified Tester (print) �� 2f �Okr+S°nCertified Tester (signature) Firm Phone # "b 17-371 _p X56 Cert. Tester No. f � O I. Date � 17 * 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 >4 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) souk\,\ MAILING ADDRESS: C4 • CONTACT PERSON/PHONE: LOCATION OF SERVICE: neg`l C� . The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable paramete' TYPE OF ASSEMBLY Reduced Pressure Principle - Reduced Pressure Principle -Detector Double Check Valve Double Check -Detector . Pressure Vacuum Breaker Spill -Resistant Pressure Vacuum Breaker Manufacturer..�AModel Number OO�NY� Size �1 Located At b12`x• Vy01,J' Serial Number 09 71 1; Is the assembly installed in accordance with manufacturer recommendations and/or local codes? T#st gauge used: Make/M( Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. N: o X0 7175V Firm Name—A) 1 __�f_ y Firm Address y�� Kz1le�;TX• Certified Tester (print) �,(+( � Certified Tester (signature) Firm Phone # 1 0— 3 7- I— 0 0oSb Cert. Tester Nd$_f 0 0 i� 1) 7 a Date I J * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS White- City Copy Yellow- Customer Copy Pink- Tester's Copy Reduced Pressure Principle Assembly Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check VaN6 1 st Check 2nd Check Initial T st �S Ll Held at k sid Closed Tight Leaked Held at *I • psid Closed Tight LeakedI Opened at psid Did not open Opened at psid Did not open at Leaked Repairs/ -� Materials Used Test After Held at psid Held at psid Opened at Opened at Held at Repair Closed Tight Closed Tight psid psid psid T#st gauge used: Make/M( Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. N: o X0 7175V Firm Name—A) 1 __�f_ y Firm Address y�� Kz1le�;TX• Certified Tester (print) �,(+( � Certified Tester (signature) Firm Phone # 1 0— 3 7- I— 0 0oSb Cert. Tester Nd$_f 0 0 i� 1) 7 a Date I 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 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) LO MAILING ADDRESS: CONTACT PERSON/PHONE: i LOCATION OF SERVICE: CO f Pell 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 Reduced Pressure Principle -Reduced Pressure Principle -Detector Double Check Valve Double Check -Detector Pressure Vacuum Breaker Spill -Resistant Pressure Vacuum Breaker Manufacturer1Tfta,_AA-5 Model Number L- 0 O Size Located At 0Y' �Q.`� r V ��� k 5� 1 erial Number Is the assembly installed in ac----- nce with manufacturer recommendations and/or local codes? Test gauge used: Make/Mi Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. N06o717 i'y Firm Name���Firm Address 65 �� �3- l �1 �ks�n Ke� Certified Tester (print)y,,\,, l�� Cernfie Teslerter (signature) Firm Phone #S\1-37° -0 b S6 Cert. Tester No. D DO J 7 Date U r 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 Cc- psid Held at �• psid Opened at Opened at Held at Initial T st Closed Tight Closed Tight psid psid psid ;Ss Leaked' I Leaked Did not open Did not open Leaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at HelLatj Repair ClosedTight '' Closed Tight psid psid psi Test gauge used: Make/Mi Date Tested for Accuracy: Remarks: The above is certified to be true at the time of testing. N06o717 i'y Firm Name���Firm Address 65 �� �3- l �1 �ks�n Ke� Certified Tester (print)y,,\,, l�� Cernfie Teslerter (signature) Firm Phone #S\1-37° -0 b S6 Cert. Tester No. D DO J 7 Date U r 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: NJ 'C) tk - BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENA CE REPORT NAME OF PWS: CITY OF COPPELL (Customer) C MAILING ADDRESS: CONTACT PERSON/PHONE: C ra LOCATION OF SERVICE: 0 S, PWS I.D. # 0570040 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 Double Check Valve /Touble Check -Detector Pressure-VacuumBreakerSpill-Resistant Pressure Vacuum Breaker Manufacturer (7f (o0 m 1 11 Model Number Size Located At Serial Number Is the assembly installed in accordance with manufacturer recommendations and/or local codes? J Test gauge used: Make/Model e� %1 F in S nn SN: �i�o7 C O y Date Tested for Accuracy: � Remarks: T The above is certified to be true at the time of testing. 1 FirmName e J� Firm Address -'T• �' 0 e- r,Tk : Certified Tester (print) O Certitted Tester (signature) Firm Phone # %7 7 3 7/ ` oaos bcert. Tester No.M001 001 0 7,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 A embly Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet CheckValve 1 st Check 2nd Check Initial Tpst (&S , Held at j sid Closed Tight' Leaked Held at ;)' (" psid Closed Tight Leaked I Opened at psid Did not open Opened at psid Did not open Held at psid 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 e� %1 F in S nn SN: �i�o7 C O y Date Tested for Accuracy: � Remarks: T The above is certified to be true at the time of testing. 1 FirmName e J� Firm Address -'T• �' 0 e- r,Tk : Certified Tester (print) O Certitted Tester (signature) Firm Phone # %7 7 3 7/ ` oaos bcert. Tester No.M001 001 0 7,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