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2017_0223_RPZ 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; ' L�� u u r'�� /' CONTACT PERSON/PHONE: r? . i ��'+ - �' ` / ' � 7 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 f�Reduced Pressure Principle ❑Reduced Pressure Principle-Detector ❑DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer /�t��t,TT� Model Number 0��%�� Size ;>7 �� Located At S� w��l/ �r1 �f'i i��e r �/'r! Serial Number l�:�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 �i � Held at�psid Held at psid Opened at Opened at Held at Imtial Test Closed Tightl-� Closed ight �� psid psid psid Leaked! '�, Leaked�; Did not open C' Did not open I I Leaked J' 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�.!/� �j�i�S T�T'�� SN: t�.�//,�?r�? (,�� Date Tested or Accuracy: —�C� � Remarks: v�z�a� /J� � �� i�'I � UlLc-C/�� 41 � -S The above is certified to be true at the time of testing. FirmName��-T�V� t"iK �/'� � Firm Address �v ,.7��K 7p/ � Certified Tester(print) �/'1 DG�'�✓l��" Certified Tester(signature) v� a��'l �L/1 G� Firm Phone#_ ��Q .S�Q--�?�� Cert.Tester N��U�/S3S/ Date v2 �.,� /� * 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: �'d�� C�u Dru m ��• I�a s, T� 7 saSS� CONTACT PERSON/PHONE: LOCATION OF SERVICE: .S�u-�h Cl�; � �m •,/ai� u/�an�9 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 C�'educed Pressure Principle I��Reduced Pressure Principle-Detector ❑DoubleCheckValve I 1Double Check-Detector ❑PressureVacuumBreaker '�ISpill-Resistant Pressure Vacuum Breaker Manufacturer lit�a'�5 Model Number OD"//rl 01 Size c� � � Located At $oU�'�1 �� c� �rY!• Serial Number /�270?� 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 �S� Held at�psid Held at�psid Opened at 2• Z Opened at Held at Initial Test Closed Tight�l�Y Closed Tight F� psid psid psid Leaked� Leaked�� Did not open � i Did not open �i-1 Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ ClosedTight�:I psid psid psid Test gauge used: Make/Model /�i l�i h S TG-� SN: oSI/Z 2 !7 9 Date Tested for Accuracy: _[- 3��/7 Remarks: The above is certified to be true at the time of testing. Firm Name�c�ivn �ir< l�r'o 5 Firm Address l��a� 79�• /,tJa�a�aGh�C ,7'7C Certified Tester(print�n�n ��rG� �f Certified Tester(signature) � �-' Firm Phone# �� s.s�� 2 Z $1 Cert.Tester No.$l�0 d 1.3 3S� Date 3 ' /�I7 *TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REPLACEMENT PARTS White-Ciry 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: � a�G'�� /� �'r' ✓-r�' CONTACT PERSON/PHONE: rez� �'I"I i �'/ ��- /7 'G�� 7 LOCATION OF SERVICE: „7/� � I�L�/'rtt1� �-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 �duced Pressure Principle ��Reduced Pressure Principle-Detector ❑DoubleCheckValve �Double Check-Detector C�PressureVacuumBreaker CSpill-Resistant Pressure Vacuum Breaker Manufacturer ��T/ � Model Number fJ� � (.�1- Size � � ' Located At Qf� �Q�rK��• Serial Number .3�`�`'�� 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 lst Check 2nd Check �� ( Held at�psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight' I Closed Tight ❑ psid psid psid Leakedi i Leaked��-1 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� I psid psid psid Test gauge used:Make/Model f�� i�//J S��' � SN: f�,5 �� o? CJ 9 Date Tested for Accu cy: � �l� '' Remarks: � c<-� G -�,'�" i � Q �-C�<9� . The above is certified to be true at the time of testing. Firm Name��?'i��'J �i-C ��-p � Firm Address�G ��X �Al � Certified Tester(print)�Uf'►1�1 (�-GrGt�s Certified Tester(signature) � �u'f ,��Gc�. Firm Phone# �Ql��j � ,�?,��'� Cert.Tester No��4 U,��f 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 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: ,�r0.�l� l��,�.r��ccrn 1�r'- ��a 5 ,7� - 7 S"Z�� CONTACT PERSON/PHONE: LOCATION OF SERVICE: e'�/� l,fJ/'an q��/ 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 I�Reduced Pressure Principle -�Reduced Pressure Principle-Detector ❑DoubleCheckValve �Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer�,{1 ct�'J�5 Model Number f�D g t�T Size ��2 , � Located At��!'LQI� �rI�.�Gt /�I7Q��nc.. Serial Number 33�L 2� 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 �5 S Held at �J psid Held at�oZ psid Opened at,� Opened at Held at Initial Test Closed Tightf�Y Closed Tight I?' psid psid psid Leaked[� Leakedl—'� Did not open f 1 Did not open ❑ LeakedC Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight'��I psid psid psid Test gauge used:Make/Model ;//��//5 Z�-5� SN: O.�//d'�d0 9 Date Tested for Accurac : l— 0' /7 Remarks: C!.�rr{h��y I'!o� r�1.G�!'I 7 G(Ll� -f'u r O1' The above is certified to be true at the time of testing. FirmName �L7'✓oI? �K �/05 FirmAddress�0/?Ox797• ��(R /�RGfi��.7/�- Certified Tester(print)��h �Gt r(.�/Gt Certified Tester(signature) Firm Phone#�QU' 5.��'22 �� Cert.TesterNo./3PDOIS�.�I Date�'I�'f7 *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