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2017_0208_RPZ �r.. 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 LD. #0570040 (Customer) MAILING ADDRESS: I.l��►,�e� 7��R►1 YD�°1 �r �o �P�� I p_y' ��a i� CONTACT PERSON/PHONE: ��'�N1— �l6QI— 9 b �il — � l�,$— LOCATION OF SERVICE: `7T0 �.`'�NUo�/ A�^►•�fL 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 educed Pressure Principle ❑Reduced Pressure Principle-Detector ❑DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker !�Spill-Resistant Pressure Vacuum Breaker Manufacturer�,t)v4TT�, Model Number�'�(1�� Size�� Located At !ST f'l�i'— e�r r ��91`!� �� 7�60 M Serial Number�ci�)�J 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 1•�psid Held at�psid Opened at� Opened at Held at Initial Test Closed Tight❑ Closed Tight n psid psid psid ��Cj�G Leaked�' Leaked'-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�1 Closed Tight❑ psid psid psid Test gauge used:Make/Model��t�y,�,��; 8�,S S— �i� SN:ic��% '� 1 �l�o�L Date Tested for Accuracy: ��L j —�� Remarks: �� Di'►'l �i�L'� The above is certified to be true at the time of testing. FirmName N�� , �'l.ec µ�}N �'NrC► � Firm Address2u�g'pt��iar�� 'itr� �reg�i"�� Certified Tester(print)��V�',�� ;r��7 1'�Certified Tester(signature) � c.� 'L� Firm Phone#K�� `,�3�-J ' �?�,pb Cert.Tester No. �' '� 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 7 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,��e�, 7Sd L��r�yfsr�l 'D�f' tp° P�e i ) � �1 Sa� CONTACT PERSON/PHONE: 3'r�'r1- 4(�9- 9�GI^ �1�,�'� LOCATION OF SERVICE: �7 S� C°�4T��e�l �r�u� 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 �duced Pressure Principle "1Reduced Pressure Principle-Detector ❑DoubleCheckValve ' IDouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer ��t��A�clG Model Number c�q m� Size � �� Located At a 1�1 v F�� (Y1�F H 1'f�l��A( l�o i1n Serial Number ,'3v"��1 o2Z 1 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ��.5 Reduced Pressure Princi ]e Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at 7. 1 psid Held at '7.Z psid Opened at -3` ( Opened at Held at Initial Test Closed Tight❑ Closed Tight ❑ psid psid psid � �� Leaked❑ Leakedl-1 Did not open ❑ Did not open ❑ LeakedCl Repairs/ Materials Used Heid at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight❑ psid psid psid Testgaugeused:Make/Model �Ol�f'tli�?I'l�� (s'- c5� ^ t�a u sN: iaa 71 Y?� Date Tested for Accuracy: �J ` ,� Y— �6 Remarks: The above is certified to be true at the time of testing. Firm Name P I� k�e��r,��r�•�°QP� � Firm A ddress�2 tl2� l�,l lr�ly� S>C�r��?/�l0 %'!'iti�i� Certified Tester(print)� C 1/Certified Tester(signature)�� ,�t�.n�� Firm Phone�'7rZ � 3 3�'j^ /2.�� Cert.Tester No. l/Sl � Date aZ " �"' a0�7 *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 LD. #0570040 (Customer) MAILING ADDRESS: � � � r� � �e � il T �7 a CONTACT PERSON/PHONE: �rh� �l�9 - 6 4 - °l (g.5- LOCATION OF SERVICE: 7 Sd �Ati1Vo�� Q('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 �duced Pressure Principle i lReduced Pressure Principle-Detector ❑DoubleCheckValve CiDouble Check-Detector ClPressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker / � Manufacturer {i(��1"T Model Number bQ� (Y)c'��Size ✓ Located At /�`T�'�GC�Y' /�t'�/' �►9�M��1f� �t�l� Serial Number��Q�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? t C 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 �C7 psid Held at�psid Opened at� Opened at Held at Initial Test Closed Tight❑ Closed Tight ❑ psid psid psid ��S J� Leaked❑ LeakedC Did not open [7 Did not open ❑ Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tigbt U Closed Tight❑ psid psid psid Test gauge used:Make/Model L e�r�l o�r� �4��'^ 5= �l j sN: 1 ao 7� 4 7� Date Tested for Accuracy: � �z�/� /,E, Remarks:��e v�'�� The above is certified to be true at the time of testing. Firm Name �a(k, �1c2" 1#Q i•!�'C V�,� Firm A ddress��t 25` L�1'l I A!"I� 3 I ��}JV d j/'�l'� � Certified Tester(print�l�1YhC-3 r7�'y� vt� Certified Tester(signature) � � �-�-� � Firm Phone#97�^ 3 3�` I�t�C1 Cert.Tester No. O � Date �- � � a�l'7 * 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: ��y; 75�0 ��1ti��Y1 Pr_ C'�d P�CI) T� 7Sa 1� CONTACT PERSON/PHONE: S, .. 1.{� - Cj — 9 t�� LOCATION OF SERVICE: 7S"'��r( '1��`�`��- �n:ae-t l . T '7 s�f�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 �uced Pressure Principle ❑Reduced Pressure Principle-Detectar ❑DoubleCheckValve �Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer �(13T'T�j Model Number B4� (Y1�� i Size �� ' Located At�7� ��`'� /n��//}/y�C�/'E/ ,Q�� Serial Number !2 3.��.- 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�psid Held at�psid Opened at c S�' Opened at Held at Initial Test Closed Tight❑ Closed Tight n psid psid psid Leaked❑ Leaked❑ Did not open ❑ Did not open i�7 Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight n Closed Tight'� psid psid psid Test gauge used:Make/Model2Qy��.�— A4�'—:5�— d�� sN: ��to'�t y 7� Date Tested for Accuracy: �- a 4' /6 Remarks: Tftr`S pet�r�C� t'S �i^ �°�i�•L! ��TL� 1�'l�k� U�� ,/�I n �f�l��C2-1- � �n 2g .�� The above is certified to be true at the time of testing. FirmName %D(K ��N�M�C� FirmAddress242� r1� rq g'f �rrtH1) ��A�(1'E',l�S Certified Tester(print)�'Rm�S ��v+z��ertified Tester(signature) � Firm Phone#N��33�j� (�� Cert.Tester No. �t'?1( 3.� Date 6�� $ " "�f217 * 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