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2017_0103 � � 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: CONTACT PERSON/PHONE: LOCATION OF SERVICE: 'J� TL�S C�'�`"` 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 ❑}�educed Pressure Principle "1Reduced Pressure Principle-Detector �7DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer � � �-- �1��Model Number � �� Size� Located At ��C?� �'�-� Serial Number 1-� � � � `�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 C� psid Held at �Z psid Opened at Opened at Held at Initial Test Closed Tight' Closed Tight psid psid psid Leaked��`1 Leaked� Did not open [ i Did not open f� Leaked`� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight i 1 ClosedTight f�] psid psid psid Test gauge used:Make/Model (�'�� /�-�� SN: ��' Z � 5�7 Date Tested for Accuracy: 1��' � (� Remarks: The above is certified to be true at the time of testing. FirmName�� 1� Firm Address �� - Certified Tester(print)� �'�'�'��1��ified Tester(signature) _ Firm Phone# �L �a� �� Cert.Tester No�P�'3�SZ- Date 1 '� � *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 GANDARA IRRIGATION INC. 3901 Clifton Dr. Richardson TX 75082 Office: 972-671-3776 Fax: 972-664-9158 Cell: 972-467-3918 Emaii: eddiegan1@sbcglobal.net 805 PRESCOTT COPPELL TX To Whom it May Concern; An irrigation system was installed at the property described above. In accordance with the city of Coppell TX . inspection requirements, we are providing the following information. This irrigation systemhas been installedin accordance with all applicable State and local laws,ordinances,rules,regulations and orders. I have tested the system and determined that it has been installed according to the irrigation plan and is properly adjusted for the most efficient application of water at this time. 1 year warranty from the day of installation. Sincerely i� . EDWARD GANDARA ��1��` ,. ,��°�>,am�e�'�,�.� ��-� ��. g� j�> 6 '��. �°�:� f�OFeeim�yynoeat..�.�.• � � ' BOt ��JA�C, .. ��ARA eane.eu•....:..,f..;. > •ecrn. � � 3'3 4.. ... , : ;�Q,. � '••� �'�� ic,�� o'i��C�