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2017_0411 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 "� `�y� n�, MAILING ADDRESS: /4�c��// � �/ifT�i� �"_u/,yC �f'��S %�- �� CONTACT PERSON/PHONE: ;�?A�� a rit-e�e �i,�- $S�d'' O i 7S LOCATION OF SERVICE: �3�lc� ,t�/diD2.�� C�yD�c"/t � 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 IReduced Pressure Principle CReduced Pressure Principle-Detector C�ubleCheckValve �Double Check-Detector �7PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker � �i Manufacturer `�`��S Model Number �� Size Located At DF�'�r/��t�7 ,�-i' s��/P �r:�•;��-4Serial Number v��- Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �.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 TightlY Closed Tight �:']� psid psid psid ' Leakedn 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 Cl Closed Tight� psid psid psid Test gauge used:Make/Model_ r��d �� 'a��s��( SN: �7��5 Date Tested for Accuracy: /��7�/� Remarks: The above is certified to be true at the time of testing. FirmName /�f / �� Firm Address /�5_7S� //esi�4-��l'� �,q��,q-� � �5'�3� Certified Tester(print)�(��f�-!��OFS � Certified Tester(signature) Firm Phone# �� 3�S-a»� Cert.Tester No.��4��- Date� u /� * 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: ��/ �- ��ll�S �w� �C�� 5 a�C/ CONTACT PERSON/PHONE: �� `�� .:?iS/�- ,�4�i' v /7S LOCATION OF SERVICE:��a ;v,U,��v (�,p�// 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 �:Reduced Pressure Principle-Detector ❑Double Check Valve ❑Double Check-Detector �lPressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker � !� Manufacturer �S Model Number ��7 �(/ Size �fF.�.� r3� ��i Located At OF�'=QivE�P�i4 � ,cf,�a �.�-�, � Serial Number 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�J� Closed Tight 'Fr psid psid psid ��,5 Leaked❑ Leakedl 1 Did not open �� Did not open ❑ Leaked�l Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight'7 psid psid psid Test gauge used: Make/Model��//� ��G�--�S GC SN: p 7��/o7045 Date Tested for Accuracy: //� 7�/�P Remarks: � The above is certified to be true at the time of testing. FirmName /`��/_ �� Firm Address_/p575 U�S��I�''"��,('�IF�S �� 7.3-�� /� �:� Certified Tester(print)��^�'1��-S Certified Tester(signatur Firm Phone#��'��S`�aa/ Cert.TesterNo.,��5� 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: I�o�� M- ��f1'�✓� �v.-C ' �� !�C'" 75 � CONTACT PERSON/PHONE: .�' E7�c_1'��/' �/f/- 5 y�'— a/75 LOCATION OF SERVICE: a�D /U/�0�,4 2 / "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 `�Reduced Pressure Principle-Detector �uble Check Valve 1 Double Check-Detector ❑PressureVacuumBreaker �1Spi11-Resistant Pressure Vacuum Breaker �,j� � �c Manufacturer !�(/�i�s Model Number��'� ��-- Size � Located At 1.•s �/�u�T f�-%��d�� '�"�� Serial Number /��o�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�� psid Held at�= 3 psid Opened at Opened at Held at Ini �al Test Closed Tight� Closed Tight Iti� psid psid psid Leaked'� Leaked❑ Did not open � Did not open C7 Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�7 Closed Tight� psid psid psid Test gauge used: Make/Model_y�5�"�� 'o?E�—�S Lt SN: �T�S1�7l�Oj^ Date Tested for Accuracy: �l�/7��0 Remarks: The above is certified to be true at the time of testing. FirmName 1�1��%'•�� Firm Address 1��7��/,��iX��.�� /��l� !, : Certified Tester(print)��5� Certified Tester(signatur � Firm Phone# ��.��?-��/ Cert.Tester No. �G7o/l��S�- 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) "` " �� MAILING ADDRESS: �yay� �f• '�R��AS 'rY�� t��S � 75 25� CONTACT PERSON/PHONE: ,C��t �Z'�c�`�+'E' ��/- S�IS`-�" 7-�s LOCATION OF SERVICE: ��"O ��d�� '�-o,o,p�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 I 1Re ed Pressure Principle �,iReduced Pressure Principle-Detector oubleCheckValve C�IDouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker ,• �'i.. Manufacturer ��,/ �� Model Numl�� K�7��- �i�;; -, - -- - =_..------_ Located At-�r G��sc/1�9�!—�Si �'�-�-.�a�*c'-C Serial Number ��d�P 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 �' l psid Held at�`� psid Opened at Opened at Held at Initial Test Closed Tightf� Closed Tight � � psid psid psid ��-SS Leaked�I Leakedl�; Did not open '.i Did not open ! I 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 �j d/l Q �� 5�t SN: O 7��O�S' Date Tested for Accuracy: fl��/!,o Remarks: The above is certified to be true at the time of testing. Firm Name ��7 Firm A ddress IOS 75 ��5✓7s2�� ,CG �(J<Y1��3 � �,S a<�� Certified Tester rint �C��^/L�� — (p ) � Certified Tester(signature Firtn Phone# ��+o`��/ Cert.Tester No. �J��llaa5,�- Date iY i � * 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 v 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) 'l , / MAILING ADDRESS: �� {- ��1�-S ��w� ��<fX� � ?'5��.5� CONTACT PERSON/PHONE: �.�r�4 %�'R�'e �/�/-5%�d�-o i 7 s LOCATION OF SERVICE: �'�� +��Y�� L'qD,nB// ?,�• 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 �]Re ed Pressure Principle-Detector ❑Double Check Valve � ouble Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer /T/�c�-S Model Number �7� ��/�/� Size� Located At.,1�- ��-�� Psr ��''a""�� Serial Number /��-Q Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �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 ��S Leakedf�l Leaked��l Did not open i-,� Did not open �-' Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ ClosedTight C psid psid psid Test gauge used:Make/Model y�Q/�� '�� SN: Q��o��s Date Tested for Accuracy: l�- /��/� Remarks: The above is certified to be true at the time of testing. FirmName�,r/-C7 Firm Address/05�7.� /�'lSt��r?'2��/�/ �1�i9� �iC� �J �38 Certified Tester(print)�� [�� Certified Tester(signature) Firm Phone#�S/��"�� Cert.Tester No.��- 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 LD. # 0570040 (Customer) Ma1LnvG aDD�ss: �4�'�5�/ � ��ll•� i'�l%.w� ,�//�+-s �. 7.� aS�,� CONTACT PERSON/PHONE: �l C��r'�r.e��e r��4/ .5 4/�'-o/ 7s LOCATION OF SERVICE: ��Jo �l/r/��.%-F�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 `1Reduced Pressure Principle-Detector uDoubleCheckValve �Double Check-Detector ❑PressureVacuumBreaker ��Spill-Resistant Pressure Vacuum Breaker Manufacturer ,�'�/�"1�s Model Number •�-/� Q�7 /�/ Size a � Located At /✓�t�- � l�9��`�s'��e Serial Number ��y 7� � Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �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 � �Tp�sid Held at ��-�7 psid Opened at Opened at Held at �al Test Closed Tight�'"' Closed Tight i psid psid psid ,$S Leaked�'�� 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��I Closed Tight❑ psid psid psid Test gauge used: Make/Model � l� �� `-�d� ��Su SN: ��1��S Date Tested for Accuracy: // /� /7 Remarks: The above is certified to be true at the time of testing. Firm Name ��• �7� Firm A ddress/O5�7S lA.s%�-��fC ,�✓�1�.�4 �_ �S��' Certified Tester(print)` �^-� �� ertified Tester(signature) Firm Phone#c��'!��3�'9'�a�� Cert.Tester No.�l�t 0/��-- Date �r / * 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) '\,, / `�� MAILIlVG ADDRESS: /'��"�� /�/' �(.J�f/<�-S T�.��-� ,i�//� � 7S�S-� CONTACT PERSON/PHONE: O�v C�ac.rr,se�`e. �?/�/- �S/�- c��7S LOCATION OF SERVICE: o?S/C3 �Dil/i,Q�.v1► �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 1=iReduced Pressure Principle ;-IReduced Pressure Principle-Detector '�_iDoubleCheckValve L�uble Check-Detector �PressureVacuumBreaker '�^��Spill-Resistant Pressure Vacuum Breaker Manufacturer �'�`A'�� Model Number `7J7� ��Q� Size /� /� Located At --� ��-�� '' /�`r��Q ��"�' Serial Number //�� 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 Inirial Test Closed Tight��7 Closed Tight i-� psid psid psid ��q.�� LeakedG� Leaked� 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 �� o��S u SN: �77��5 Date Tested for Accuracy: /l /7 ��o Remarks: The above is certified to be true at the time of testing. Firm Name ��! / �? Firm Address_/�J7.5 �/�"�TJ� /��c ,��,� i,L� 7J�� Certified Tester(print�� v� Certified Tester(signature�-,� Firm Phone# ��-3��a a�'� Cert.Tester No. �'V��G�5 2 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