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2017_0314 IRRIGATION DOMESTIC V 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: .. /� � 7 �� CONTACT PERSON/PHONE: ;,,• � - �I7 LOCATION OF SERVICE: �) 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 ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �i�tTs` Model Number �L��Q� Size��, Located At /Vi�y�l� �f �i✓� ��yrnd /«4 M Serial Number ,1� ��_ 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 I� psid psid psid Leaked� LeakedC� Did not open f� Did not open �1 Leaked�-] Repairs/ Materials Used Held at �psid Held at psid Test After Opened at Opened at Held at Repair Ciosed Tight Ll Closed Tight❑ psid psid psid Test gauge used:Make/Model � � SN: Li��9�� Date Tested for Accuracy: - Remarks: The above is certified to be true at the time of testing. FirmName ��/��i Firm Address/(.�� ,�,sti� /�ar1�C�c� ��i�s 7��,�,� .r Certified Tester(print)� � �' � ��r Certified Tester(signature) ,,.yyv. Firm Phone#��- �l,l�-;`�..�.�/ Cert.TesterNo. �p�Llj�,��:� Date .�Z��/��/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 V 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: �✓ � ' � 7�i 1 CONTACT PERSON/PHONE: �crt c-t��vi� v?I��_ �/�- (�7`j LOCATION OF SERVICE: 5�� L✓�T�� 'w� 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 f 1Reduced Pressure Principle-Detector L�oubleCheckValve ❑Double Check-Detectar �PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �J1/� � Model Number (la�/1/11�]� Size � ,� Located At /V��rt �,�� I��vn ��o�.,� Serial Number �;�L�iC1,j� Is the assembly installed in accardance 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 TightCvl� Closed Tight ►� psid psid psid Leaked❑ Leaked�_:! Did not open C' 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 � r/ � SN: D 7C��JO�F1� Date Tested for Accuracy: �- -.��/� Remarks: The above is certified to be true at the time of testing. FirmName��nC_„� Firm Address �Q�7�i �i�i� 1��,✓�c /�� /��`its- �J:�� Certified Tester(print) '�� /{�i ;, �f Certified Tester(signature)� � Firm Phone#�/�/-��- a��f Cert.Tester No. ,�p�Qi`:��>�� Date,�-/y�/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 LD. #0570040 (Gustomer) MAILING ADDRESS: - � � � � � � 7S C CONTACT PERSON/PHONE: ��.�� v .�/ � - '�7 LOCATION OF SERVICE: j ;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 i�Reduced Pressure Principle �'Reduced Pressure Principle-Detector �ouble Check Valve Ci Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer Vy,.!�T"f's Model Number C1� 7/Ii�I Q I— Size �� Located At�t�Y/� ��-j /i✓t! ��srv�✓� /�c�+;r Serial Number /�/ ']��`� 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/. 3 psid Held at �, y psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight �� psid psid psid Leakedn Leaked�.� Did not open ❑ Did not open ❑ Leaked�1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight C� psid psid psid Test gauge used:Make/Model�� SN: �,5 LI�� Date Tested for Accuracy: o�- � '.��/i 7 Remarks: The above is certified to be true at the time of testing. FirmName �� Firm Address /�5 �� s�s� �c✓7r /�� s��as ��,�,� Certified Tester(print) � ;� Certified Tester(signature) Firm Phone#�y-j C/�-,�;,�v�l Cert.Tester No. ,G'pC/Ll/.`��Date j' �/�-j�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 LD. #0570040 (Customer) MAILING ADDRESS: � ��' � • - I 7 ` CONTACT PERSON/PHONE: � t� /�I- - f 75� LOCATION OF SERVICE: l � + k 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 JReduced Pressure Principle-Detector �ouble Check Valve �Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer ��f Model Number�lL1�/1/1 J�r Size �„ '�/�S J/�C /� . �-- / Located At ��i--�r�� G��"�/-✓��v.l�t�1'�Serial Number /��7 ��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�psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid Leaked❑ Leaked��l Did not open ❑ Did not open ❑ Leaked��l Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Helc�at Repair Closed Tight CI Closed Tight❑ psid psid psid Test gauge used:Make/Model � � SN: [�_5 Q��,� Date Tested for Accuracy: •�- � - G'�� Remarks: The above is certified to be true at the time of testing. FirmName A�"/JC� Firm Address �� 1�St�. /�vk �� J��/�� 13� Certified Tester(print)��'/1 t� 9 �: '�.� Certified Tester(signature) , � � — Firm Phone# �/�-3LJ�-��) Cert.TesterNo.J3j�C(�l��_��j Date �-%� -f 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 1.D. # 0570040 (Customer) Ma1LIN� aDDREss: �C1Q rr�c ov� I�k�,,,,. ,-,�, ell 7`X 75"0' CONTACT PERSON/PHONE: /�c,, Ci,,,-l�vrr � /U- g- l 7�i LOCATION OF SERVICE: S(.1�I ��E� c/� �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 � DoubleCheckValve �ouble Check-Detector Pressurc Vacuum Breaker Spill-Resistant Pressure Vacuum Breaker Manufacturer �/1/_��, Model Number `��7U.X[��_Size '� Located At ii1��.5�' �iv��' ��P�►�e✓t ��J�w►, Serial Number l��Q,��7 Is the assembly installed in accordance with man�ifacturer recommendations and/or local codes? �5 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 Opencd at Held at Initial Test Closed Tight'�'� Closed Tight �� psid psid psid Leaked� I 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 �Ii�J��/�i! SN: �1 Z�� . Date Tested for Accuracy: �'?S � � �'7 Remarks: ��""{ �/.�ec�� tii�(� . The above is certified to be true at the time of testing. Firm Name,/�f-/�� Firm Address ��j �7� I1�5l��, �ir✓�C ��. ��is ��,3�' Certified Tester(print) ' ��- ,� ��;� ,�� Certified Tester(signature)_/_� �-- Firm Phone#,��-,,3��-, ;�,�� Cert.Tester No.��C��:;7E/� Date j ��/y�-/� * 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: y L1�I �'��c��y� ��i('wt �� • l 7 `q CONTACT PERSON/PHONE: � oh - �,� ✓ie ,� U-_ �3 - /7S LOCATION OF SERVICE: .SL�(.1 �-,��,��;� L�i�w�, The backflow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certitied to be operating within acceptable paraineters. TYPE OF ASSEMBLY Reduced Pressure Principle Reduced Pressure Principle-Detector �w�oubleCheckValve � Double Check-Detector PressurcVacuumBreaker Spill-Resistant Pressure Vacuum Breaker Manufacturer r/�/_��5 Model Number (�CI 7�v2 Size }�4 �� Located At �e5� �av,�t' ��f-d��v7� ��v✓t.. 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 TighYVl' Closed Tight � psid psid psid Leaked � Leaked � Did not open Did not open Leaked Repairs/ Materials Used Hcld at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight ' ClosedTight psid psid psid Test gauge used: Make/Model � SN: Q5��Q��,� Date Tested for Accuracy: c�' "�� Remarks: The above is certified to be true at the time of testing. FirmName ��,-� Firm Address %Cl�J�j (,s�� ✓�(c /C��. ��/c��7j�-,,!'��' Certified Tester(pr:nt)��- �r � � Certified Tester(signature) Firm Phone# ��y• ��--��, �� Cert.Tester No.��L1C3j`,��3 Date j��/�/-�� * 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: fv� �� I�i� -, � l ` CONTACT PERSON/PHONE: � r, �.� � v�� - � LOCATION OF SERVICE: � � 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 �v�ouble Check-Detector �'PressurcVacuumBreaker -�Spill-Resistant Pressure Vacuum Breaker Manufacturer �/�/.�TtS Model Number 77�UC�A Size� Located At �f+�`� �i�,,�� , �%- /�,rr,✓.� Kc��y:,rt Serial Number /��//� Is the assembly installed in accordance with manufact�irer recommendations andlor 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 V� 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 Opcned at Held at Repair Closed Tight � Closed Tight �� psid psid psid Test gauge used: Make/Model �� SN: G�,.`�j�Et��c� Date Tested for Accuracy: Remarks: The above is certified to be true at the tiine of testing. FirmName �� Firm Address ��.�JS LS��; �� I�� ,�� j,;1�,� Certified Tester(pr�rr);J��.;��,�t �e�,��i�,� Certified Tester(signature) Firm Phone# ��a��- �C�`-�� Cert.Tester No.��LIj=�L�� Date � �%y �/,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) ,,, MAILING ADDRESS: � ✓t' f/ ��i�C �. � /� 75 �� CONTACT PERSON/PHONE: / -��,� - / - - 1f 7�i LOCATION OF SERVICE: �i � k� The backtlow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be operating within acceptable para�neters. TYPE OF ASSEMBLY � �Reduced Pressure Principle -Reduced Pressure Principle-Detectar �VboubleCheckValve Double Check-Detector Pressurc Vacuum Breaker Spill-Resistant Pressure Vacuum Breaker Manufacturer �J1�ia�'��s� Model Number �(,J 7i(/�� Size 3,/zj " Located At /(f�N�� ,u�1� �i,. �i✓c �-�rw•-+r� j��i� Serial Number (�� Is thE assembly installed in accordance with manufacturer reconunendations and/or local codes? ��5 Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve I st Check 2nd Check Held at �. � psid Held at�psid Opened at Opened at Held at Initial Test Closed Tighth� Closed Tight � psid psid psid Leaked '�� Leaked '� Did not open Did not open Lcaked Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTi�ht ClosedTight psid psid psid Test gauge used: Make/Model �� SN:_��,� Date Tested for Accuracy: �-. � -� 7 Remarks: The above is certified to be true at the time of testing. Firm Name_,�/��-�� Firm Address ��j ��j �s��t l�vK � ��,��,�,�� Certified Tester(p►-;rt) � �-� � � �,�. Certified Tester(signature) t '�'� Firm Phone#,. �U- 3L�C�-;,7�� 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