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2017_0316 IRRIGATION DOMESTIC FIRELINE_c� The following form must be completed for each assembly tested. A signed and dated ariginal 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: n� is �ai iw��/ �e .�c. � � 7� d o� CONTACT PERSON/PHONE: � Gvhi 1►1� � � � � LOCATION OF SERVICE: 7 /D wa�J 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 �ouble Check Valve �i Double Check-Detector ❑PressureVacuumBreaker f iSpill-Resistant Pressure Vacuum Breaker Manufacturer G�����!►V S Model Number C/cs� Size '3�_ Located At �d�'/�I�,,.tsJ CO^'"N� p�f4(�� �N ���i`Serial Number 3�3S�I S 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 a, o psid Held at ��� sid Opened at Opened at Held at Initial Test Closed TightQ�l Closed Tight� psid psid psid Leaked''1 Leaked' I Did not open � Did not open ❑ LeakedC Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight��l ClosedTight❑ psid psid psid Test gauge used:Make/Model /11/�"I�t��(ST ��✓C-C SN: oa l��.�5� Date Tested for Accuracy: �- /7- /7 Remarks: The above is certified to be true at the time of testing. FirmName�(�.Q ��� Firm Address/f.Z3S/ �.1✓/►7�0/Pi �h 1.�.�9-WIS �A� 7Sv�� Certified Tester(print�'/9-M�S �KJOri�l� Certified Tester(signature) Firm Phone#�, S�� .3�p�1 Cert.Tester No.IR�"���G Date__� ' ��i��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 far 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) -,I MAILING ADDRESS: ' D t �t�i�v �AS3� �� x 7Sd D/ CONTACT PERSON/PHONE: A ^r �►� qa LOCATION OF SERVICE: 7/ 4� The backflow prevention assembly detailed below has been tes ed 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 ❑Double Check-Detector ❑PressureVacuumBreaker ''.Spill-Resistant Pressure Vacuum Breaker �i Manufacturer �-C�Gp Model Number ��� Size r� Located At !-�'�w� t�j r" 'Q�d� by /��I��/l� Serial Number 'U� 7��7 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? -t.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 �� psid Opened at Opened at Held at Initial Test Closed Tight� 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 C Closed Tight� psid psid psid Test gauge used:Make/Model /1r���"k>�S� g y.5"� SN: oa � 7�s9� Date Tested for Accuracy: �' �7' � 7 Remarks: The above is eertified to be true at the time of testing. Firm Name �QL ��P� Firm A ddress ��.jsl �K,l'iM1/Q/ri p^ �$�is � 7.So�� Certified Tester(print��M�S ��O�hS Certified Tester(signature) Firm Phone#�7�S(7 3 6�� Cert.Tester No 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) Ma1Lnv�ADD�ss: ' �� �+t �'IQSD ,pr9- 7� �.�do/ CONTACT PERSON/PHONE: m �� h �'7Q � o'� LOCATION OF SERVICE: 7/ 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 �Double Check-Detector ❑PressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker y Manufacturer I.u, L�Iw S Model Number ��� Size � Located At �Ot9e��i.w�� CdN wr►o��{/�Serial Number � � 70�� 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 1 Did not open l�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❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model���—k�.�Sy ��{J'r`.r SN: ��/7/.s��o Date Tested for Accuracy: � �7` �7 Remarks: The above is certified to be true at the time of testing. FirmName �(�.Q ��PQ Firm Address� s� ��•VMAI� Qn �fi�3 � 7.�p?aU T Certified Tester(print)�l•'}��'+'�•1S �/11 t�^'Jn S Certified Tester(signature) �� Firm Phone# 47a ���.�j��Cert.Tester Na��fX,��_Date c3 ��i"`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 ariginal must be submitted to the public water supplier far recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS LD. # 0570040 (Customer) MAILINGADDRESS: �0� 0 N.�'�N /�c� oC '�a+bf CONTACT PERSON/PHONE: n� �7 �� 9 LOCATION OF SERVICE: 7� w The backflow prevention assembly detailed below has been t sted 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 �PressureVacuumBreaker �lSpill-Resistant Pressure Vacuum Breaker Manufacturer (�J.�K��i!S Model Number 9�fl Size� Located At �/9�u u� ►w �j�p�v� �� ��dj.�-. Serial Number ��'�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�psid Held at ��J'r psid Opened at Opened at Held at Initial Test Closed Tight�] Closed Tight Q9. psid psid psid Leaked❑ Leaked❑ Did not open LI Did not open ❑ Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ Closed Tight❑ psid psid psid Test gauge used: Make/Model /�'>>d' Ct1�ES� g y.s"� SN: ��)7��g p Date Tested for Accuracy: o� ' / 7� �7 Remarks: The above is certified to be true at the time of testing. FirmName j��.t, �'elP Firm Address � O M ��('i�/r 1tM��G1 T 75"�a Certified Tester(print�ll1�s �/1/Ol�^f Certified Tester(signature) �t�/�— Firm Phone# R 7p� J~6 7 3�G� Cert.Tester No.BP��� � Date �� �6`� *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) MAILINGADDRESS: ►+0� � ��� � v ��1� Ur1s 7Sp�0� CONTACT PERSON/PHONE: p dtJ I�� �) 7oZ y �p1 LOCATION OF SERVICE: The backflow prevention assembly detailed below has een tested and maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY ❑Reduced Pressure Principle ��lReduced Pressure Principle-Detector ❑Double Check Valve �Double Check-Detector ❑PressureVacuumBreaker �-��Spi11-Resistant Pressure Vacuum Breaker Manufacturer (Ai���tl wS Model Number 3�� Size � Located At V/4-V�l� Iti Fnow�A� ����— Serial Number � l��``�p Is the assembly installed in accordance with manufacturer recommendations and/or local codes? � .Q 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 Leakedi�l Leaked�� Did not open J Did not open n Leaked��l Repairs/ Materials Used Held at psid Held at psid � Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight i-1 psid psid psid Test gauge used: Make/Model /�'1��`- (,t�.fs� ��/,j'j SN: ��?j_�Cj V Date Tested for Accuracy: a-/�` /7 Remarks: The above is certified to be true at the time of testing. FirmName ���-��,° Firm Address /Q�/ �Y/NAI�i Q►" �¢ r �✓O�o7� � Certified Tester(print)��MJS �/�/Q('�n,�Certified Tester(signature) Firm Phone# Q7o� U�b7 3,66� Cert.Tester No. Date ��/b`�� *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