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2017_0208 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 recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) MAILING ADDRESS: � z -� � 7 S�� CONTACT PERSON/PHONE: 'T'� — �G`�^46�f , � ,� LOCATION OF SERVICE: ��'l;'a �u�►um*� D r�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 ❑Reduced Pressure Principle �Reduced Pressure Principle-Detector ❑DoubleCheckValve uDouble Check-Detector �PressureVacuumBreaker '�Spill-Resistant Pressure Vacuum Breaker Manufacturer �(�At Model Number QO�'1 CQ� Size / ' � Located At atiiu ��ol� d'�i^Pqk I�,a tJt�/v�✓' .�� r7K Serial Number �4p� �i� 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 lnlet Check Valve 1 st Check 2nd Check Held at 7� 1 psid Held at 7°.Z psid Opened at `,3,_y_ Opened at Held at Initial Test Closed Tight❑ Closed Tight ❑ psid psid psid Leaked❑ Leaked�7 Did not open ❑ Did not open ''_-1 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 �,�- `?-Ao�� sN: l aa'� y�� Date Tested for Accuracy: �O " o'� " ��i Remarks: The above is certified to be true at the time of testing. FirmName�,�k��o��Mi�FKI� FirmAddressol4�,� \�� I1�Qt�1� S) �+�r�ntD. PrA�'r�'��x Certified Tester(print)�_w�S SL.ti.T�uvCertified Tester(signature) � Firm Phone#Q7� �3�ei^ I�d�D Cert.Tester No. O l/ � Date a- �Z * 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: e �O � � fil `D r (�D e. � CONTACT PERSON/PHONE• �`� - 4(z� - °!!�� ci 1�� LOCATION OF SERVICE: Z,�� t,► �O � I��Ca,� D u � � l` 7SO 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 ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector �Double Check Valve ❑Double Check-Detector �7PressureVacuumBreaker ��lSpill-Resistant Pressure Vacuum Breaker Manufacturer �.,cJ RTT� Model Number Q�"7 YY► 4 � Size �� Located At f��l'�f}�JC� Tp /'iY>9P►'�7'�/ Serial Number ��'Z( c� Is the assembly installed in accordance wrth 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 Cbeck Held at!� psid Held at 1+ psid Opened at Opened at Held at Initial Test Closed Tightl�l� 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��ti�� ,�� ' �O►1 SN: /�tb 7/�T� Date Tested for Accuracy: Remarks: � o F y K��/ �'ni r rt}rl�+l� The above is certified to be true at the time of testing. FirmName�ol�, /YI,�a��r►r'e�j Firm Addressa4Jly t�r�l/H/'l� 9/ �r:�fl�� I�A�'�i'E' ix Certified Tester(print)�v�S �1'v�nl�S�vrtl�ertified Tester(signature) � Firm Phone#�I7� , 3�i-/�CY� Cert.Tester No. /7d/I�3.� Date 2- � `� �bl� *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) r� .-- MAILING ADDRESS: � � �' "7 4 K� CONTACT PERSON/PHONE: � � t,t — LOCATION OF SERVICE: O 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 ❑Reduced Pressure Principle �Reduced Pressure Principle-Detector �heckValve �lDouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker ,� Manufacturer ��-?-TT 5 Model Number�0'� �'1 1¢"�' Size � Located At,�'f,r i�AN te e %v P��r.^T��_Serial Number �� 7� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? L`'� 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/• �l psid Held at�psid Opened at Opened at Held at Initial Test Closed Tigh losed Tight � psid psid psid �� Leaked❑ LeakedC'� Did not open C; Did not open �1 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 L,o��{��/ ��;5'�=G�I/ SN: I2Q7J N�i� Date Tested for Accuracy: � o2F'J " /6 Remarks: �j= �jl �3ti �h�%i►,19 a i L The above is certified to be true at the time of testing. Firm Name��,��'Go Firm A ddress��2„r ,d,�%/�rU 9/ ,<��"�Nc� �i�f i'r�� ! � Certified Tester(print�A n,�5 _��;t��ertified Tester(signature �� Firm Phone#7'�'d.- 3�� /2�d Cert.Tester No. �y3� Date �" � '/��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) ,�1 -�" MAILING ADDRESS: '7 O C.'' � r ' I CONTACT PERSON/PHONE: '�' - � — ' ��II LOCATION OF SERVICE: 7 j 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 �i Reduced Pressure Principle-Detector �uble Check Valve [�I Double Check-Detector �PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �i��TTS Model Number t9E,`�/?'f 1 Q� Size �� r Located At�!T��P�° �'�1 //'m/��"'n/ Serial Number (,� 7a� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �E'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 j, �psid Held at��psid Opened at Opened at Held at Initial Test Closed Tight��' Closed Tight _ psid psid psid Leaked❑ LeakedC� 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 n Closed Tight I�1 psid psid psid Test gauge used:Make/Mode11��-K�f,bV'l�( 8GJ' -,S- �p� � SN: /:Co�/4�2 Date Tested for Accuracy: �v�' ✓� ' �� Remarks: 3 d f�y.��TE''aT��t�e � The above is cerrified to be true at the time of testing. Firm Name/�� e�l��Mc�'�� Firm Address�4Z,' /''�a fih r U s? ��•�Ir/J %N�i`��'p �( Certified Tester(print�RNttS �;�DS�r.� Certified Tester(signature) Firm Phone#�1?�' 3,�%' 7�� Cert.Tester No. ��`I y3,� 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 . �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 I.D. #0570040 (Customer) MAILING ADDREss: 7s¢ fs' > G '� / 1 f� CONTACT PERSON/PHONE: L � LOCATION OF SERVICE: � '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 �e�rb�te Check Valve �Double Check-Detector ❑PressureVacuumBreaker '-1Spi11-Resistant Pressure Vacuum Breaker � r Manufacturer/`•,trl�-�j'� Model Number �7�1 c�/ Size�_ Located At�i�l'I�i'f}N�►Q `��.�e�T�/ Serial Number J Y�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? i� 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 I. 3 psid Held at j,�l psid Opened at Opened at Held at Initial Test Closed Tight losed Tight id psid psid �5� Leakedf.� Leakedl- 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 ClosedTight❑ ClosedTight'� psid psid psid Test gauge used:Make/Model G�fJ/�'/h/D�'/`� �4,j�' • S�- P.lfi I�SN: 1�Q�l i�7� Date Tested for Accuracy: �� ' J6 Remarks: ��='�/�ci f,yT'�/}x,� Ta !'�e�DPr�7✓ The above is certified to be true at the time of testing. Firm Namer"8 i� �`�1Q°��'�F1 N�'�'� � Firm A ddress��I 2s '�r I l�ei r►�s't (�r.�rND 7r A��i`t'� � . Certified Tester(prin n,►��5 � ��,•,,]1�r�ertified Tester(signature) � Firm Phone#-�"J 7,� - .�,� �- f,2Gt�J Cert.Tester No. QC�%�� 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. #0570040 (Customer) MAILING ADDRESS: �7 � N N �''� '��/ Tx �`�� CONTACT PERSON/PHONE: �l r — �it 6?-� d — LOCATION OF SERVICE: 7SlJ bY��' � 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 �R ced Pressure Principle ❑Reduced Pressure Principle-Detector oubleCheckValve [_;Double Check-Detector ❑PressureVacuumBreaker '�Spill-Resistant Pressure Vacuum Breaker r Manufacturer�� `K l l�1� Model Number g�J'1d Size�_ Located At J"�1�t /C�',s��" /��l� Serial Number,r7��4� ' Is the assembly installed in accordance with manufactwer 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��psid Held at�psid Opened at Opened at Held at Initial Test Closed TightLl— 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 J Closed Tight❑ psid psid psid Test gauge used:Make/Model!-c�7 �Dvf�l r�4�= � ' 0.�l l SN: /2C'17� y'��. Date Tested for Accuracy: ��it� 'l� Remarks: The above is certified to be true at the time of testing. FirmName /"��C�(7Sl�c�f ��'� � Firm Address7tiZ3 1�'ll9N)) .3�T rw+9N'd�i��nY �'� Certified Tester(print�l�� .y c�.v�Uld� Certified Tester(signature) � Firm Phone#�`�� /�� Cert.Tester Na Date � �� t� * 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