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2016_1222 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) ° Ma1Ln•r�aDD�ss: �c �,1,�1' �,�� 2� 3 Ca«. �o..-�� CONTACT PERSON/PHONE: g'�Z �,/�Z ��O� LOCATION OF SERVICE: /y/� �' .�d�,-_ ��— 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 �oubleCheckValve ❑Double Check-Detector 1PressureVacuumBreaker !Spill-Resistant Pressure Vacuum Breaker ,d Manufacturer � e,�� Model Number ��-7 M 1 C'�T Size� Located At /1/o r-�� .y,.r�.-�� ,��%x Serial Number y �� 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 psid Held at psid Opened at Opened at Held at Initial Test Closed Tight'� Closed Tight ❑ psid psid psid Leaked� Leaked!r✓ Did not open �_1 Did not open '� Leaked[� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight L� Closed Tight� psid psid psid Test gauge used:Make/Model L�:�k,..s T C� �� SN: �7 O��6 �1� Date Tested for Accuracy: i��' G�/� Remarks: The above is certified to be true at the time of testing. Firm Name r-�-.�� '-�'.o.� ��p ��.�irm A ddress <'o ' F" T?� '! Certified Tester(print) S �;�f�� fo Certified Tester(signature) Firm Phone# FS 0'7 F 3�l ��Cert.Tester No. � �f y �`�Z Date ' � f�' * 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: ��,�f'� ,�a iP� �Q b '�� Ga.�� ..�� CONTACT PERSON/PHONE: �'7 2_ <;/�_,? _ �/.��O LOCATION OF SERVICE: jt,l� � ,_,�'.-0,,�,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 �Reduced Pressure Principle �IReduced Pressure Principle-Detector ❑Double Check Valve �ouble Check-Detector '"'PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer j4L�� Model Number � � `� Size �. (�O '� Located At EQ g-f �Qu �f �c,,. f�e..�Serial Number I � - Z`�' O ;� Is the assembly installed in accordance with manufacturer recommendations andlor 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 3.� psid Held at 3.�psid Opened at Opened at Held at Initial Test Closed Tight�� Closed Tight �i3/ psid psid psid Leaked'r' Leaked i Did not open I.I Did not open [I Leaked�l Repairs/ Materials � Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight C7 psid psid psid Test gauge used:Make/Model j,,L��/ �,'�.z T�_� SN: p�o�-t f�A3 Date Tested for Accuracy: i'p Remarks: � The above is certified to be true at the time of testing. � � FirmName .�„�e,r„+� �rf F�e �r-�irm Address,54y/ .N,dwa.,,, �t.J T'x 7��//� Certified Tester(print)Se�,..� �,� ��e..�Certified Tester(signature) � ��—=---�� Firm Phone# �'/"7_ '�3�. �� o/ Cert.Tester Na d c��y p q,�Date �.� • � � * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS � **USE ONLY MANUFACTURER'S REPLACEMENT PARTS i White-City Copy Yellow-Customer Copy Pink-Tester's Copy j IRRI6ATION DOMESTIC FIRELINEJ,� 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) a MAILING ADDRESS: � ^/��,,�� h,� � f'.�� a. -f a.r- CONTACT PERSON/PHONE: �`�L _ �,.�- . ��o LOCATION OF SERVICE: i�/O � �'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 1Reduced Pressure Principle-Detectar �ouble Check Valve 1 Double Check-Detector �7PressureVacuumBreaker iSpill-Resistant Pressure Vacuum Breaker Manufacturer �a,-�s Model Number d 0�7 1�'l3 Size . ?.� �� Located At _Q.;� i a,,,,�f l i.. �.z��Serial Number ,2 Q� '7 / / 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 Z. Zpsid Held at Z e� psid Opened at Opened at Held at Initial Test Closed Tight�i.Y Closed Tight ��✓ psid psid psid Leaked❑ Leaked�,� Did not open f7 Did not open f 1 Leaked� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight Cl Closed Tight❑ psid psid psid Test gauge used:Make/Mode1�1,��,�,,s -7"�,�� SN: c�?G? 7/��!3 Date Tested for Accuracy: �O��.� ��il� Remarks: � The above is certified to be true at the time of testing. � Firm Name ��,-.K,"-�,•o�,/ F,=�.z i=��-tFirm A ddress S�'�1/ �l;e/..�.,. F'�„I �X ��l>`7 Certified Tester(print),o�,,,. �,-t/��o,t Certified Tester(signature)�,,L� _ , �� C Firm Phone# $/7. F��cJ_ �,�G, / Cert.Tester No. �O/�/ O 9 Z Date ZQ/� *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS i 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: �o,..,./.� �a ,��Qe L � L 3 �d�� C.�f•� CONTACT PERSON/PHONE: 9�-�'L_—��2 �� LOCATION OF SERVICE: /yf O � Ss n/ � �E p 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 C�oubleCheckValve f��Double Check-Detector �PressureVacuumBreaker '�Spill-Resistant Pressure Vacuum Breaker Manufacturer i,�/a-{�s Model Number O G�� /�'I/ G2T� Size Z . �O '� Located At 5�,�,�� .-�o c- 1ooX Serial Number y�,� / G� 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 /. '�psid Held at��psid Opened at Opened at Held at Initial Test Closed Tight�� Closed Tight �� psid psid psid Leakedl�� Leaked��.� Did not open !_i Did not open � J 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/Model /_/,�/�,;.� TG S SN: �� O?/� 9 � Date Tested forAccuracy: /G�� `� d�� i Remarks: The above is certified to be true at the time of testing. � FirmName f�;�e.�_s,�� f,-�P ��tFirm Address�4�// ,.�/;t/.,,h,u F't,,/ TX '�G�//�-7 I Certified Tester(print)�e�_ ��yf�-fa�.Certified Tester(signature) .,/��_ � � � Firm Phone# �A'7_ �3�J_ ��O f Cert.Tester No. ��i�,/O 9? Date � c? La *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 j � 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: �o�..�� h � -�r l'��^f�-'-r" CONTACT PERSON/PHONE: 9��7 Z . ��=..�_to� �� LOCATION OF SERVICE: /d//c� � ��..t 8/�.. L 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 ❑Reduced Pressure Principle :�Reduced Pressure Principle-Detector f�ouble Check Valve I-i Double Check-Detector �PressureVacuumBreaker '-lSpi11-Resistant Pressure Vacuum Breaker .i Manufacturer �T�,� „ Model Number �� Size �.� 00 Located At s�,-,,;�� „(?�� .,�.�fP r Serial Number �� O� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? o .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 psid Held at�3 psid Opened at Opened at Held at Initial Test Closed Tight��-i Closed Tight � psid psid psid LeakedC� Leaked��l Did not open ��i Did not open �_-] Leaked�J Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight CI Closed Tight�1 psid psid psid Test gauge used:Make/Model G�l;% ,'�,s T�� SN: �-�p� i'G, �i 3 Date Tested for Accuracy: !�� Z4/�� Remarks: The above is certified to be true at the time of testing. FirmName_1-�-� r<��t�r"�/ F;�� ,1�k'irm Address S�</� Msd.,.a., F�t.,/ T3C 7�//� Certified Tester(print),��,,, �,��r�.�o,� Certified Tester(signature) -�-�--�� Firm Phone# �!"7, d'��/, �y O f Cert.Tester No. �C?1�=/(?� Z Date Z Z� ZO� * 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: �' � �a�o �,� /� ;-��tara C.-�-N'f�r CONTACT PERSON/PHONE: r'I'�2 �/�o��p� LOCATION OF SERVICE: i�n - � �, �L6 -��f��- The backflow prevention assembly detailed below has been tested a�ntained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector C�'�ouble Check Valve ❑Double Check-Detector �JPressureVacuumBreaker �iSpill-Resistant Pressure Vacuum Breaker Manufacturer J�,��< Model Number c��7 Na� ��Size�� Located At�---� L/�,,.4�f Serial Number `Q�,��' Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ,a 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.Fpsid Opened at Opened at Held at Initial Test Closed Tightf�Y Closed Tight [� psid psid psid Leaked��7 Leakedl�� Did not open I� Did not open 'i 1 Leakedi i 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�,1�k ' t T�`�,_�� SN: Q 7�j c��i z Date Tested for Accuracy: ��,�� f� Remarks: The above is certified to be true at the time of testing. Firm Name n.-,,��s,-�;'r_�/ ��. ��,-r'Firm A ddress S�> �9,al�.a u �i.� T"�C �C/�-7 Certified Tester(print)�'v�.,. �,��rtified Tester(signature)� , � _ Firm Phone#��. S�(. (2�/O i Cert.Tester No.��c+/p Qj Z 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 PRE�ENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) a � MAILING ADDRESS: � - - CONTACT PERSON/PHONE• y � '�� ;�.�C? n LOCATION OF SERVICE: ,��,�n �' 'r��.�.,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 �lReduced Pressure Principle f]Reduced Pressure Principle-Detector �DoubleCheckValve I�ouble Check-Detector ��iPressureVacuumBreaker ' !Spill-Resistant Pressure Vacuum Breaker Manufacturer�/a, s Model Number ��" � Size $ . C?G'�� Located At tti/�� Va,<„ �7' Serial Number /� - /S � � Is the assembly installed in accordance with manufacturer recommendations and/ar local codes? p 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 3_ G�psid Held at�sid Opened at Opened at Held at Initial Test Closed Tight�,,l� � "Closed Tight ��iY psid• psid psid Leaked:.l Leaked'�' Did not open L' Did not open �7 Leaked�l 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,.J, f�<,,,..� /`G �� SN: G'7 C��i(�� _� Date Tested for Accuracy: �/�2��e�� Remarks: The above is certified to be true at the time of testing. Firm Name l�;,,�� ;�-/�'� �,,� 1 F r� �irm A ddress �9�,// �J�,/ ��.��, �L.J TX. '?��//`7 Certified Tester(print)5��..� ,�, ��n,.Certified Tester(signature)� --�-��"—�� Firm Phone# �s'/`�. �s��, �c/01 Cert.Tester No. �-��-��10 �? � Date 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