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2017_0424 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�[� ��`LI h�► CONTACT PERSON/PHONE:�G�(j��?, LOCATION OF SERVICE: ;,�� 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 ❑Reduced Pressure Principle �Reduced Pressure Principle-Detector [5'�ouble Check Valve 17Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer\A �ty. �� Model Number '�tJ� �1`(1� Size a �� Located At �i �- h� 1�-�� d Serial Number �,�p t- L,C!h+b�,-('i 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 t . 1 .� Held at� psid Held at�psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight +� psid psid psid � Leaked��l Leaked��I 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�(�,-�,1��S� 1��S-��C�2-�1 SN: U 1�132�� Date Tested for Accuracy: �-}��'1 �70�'1 Remarks: The above is certified to be true at the time of testing. FirmName�ll��rl�n r 1��c��`��L��Firm Address\(�C"IS �/��c_1L��. �.�,1\GS.�Z "1�2� Certified Tester(print)�fi�dlc��1'�c�;1L�+r Certified Tester(signature) Firm Phone#?.\�l-3'��-�ZZ 2 I Cert.Tester No.`$�bU��3`33 Date ��Z"1��G 1—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) MAILING ADDRESS: �Zu�..l CONTACT PERSON/PHONE• �cm �� LOCATION OF SERVICE: ►�,15 �r ��N�' 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 �oubleCheckValve -1Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer�{� Model Number �U Gi Size �� Located At ��{� b41 �c_d Serial Number D��`1 C� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �cS 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 2.0 psid Opened at Opened at Held at Initial Test Closed Tightl� Closed Tight f� psid psid psid Leakedl� Leaked❑ 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 CI ClosedTight❑ psid psid psid Test gauge used:Make/Model �1C`-we5� I��5-5-UL�� SN: U31�1 3�L�'t� Date Tested for Accuracy: �-1 ��l �2.0 t�l Remarks: The above is certified to be true at the time of testing. ' Firm Name��'�.��`rc��rc;Ftch�SY, �-1�o L,7 Firm A ddress�(�1S �t s�C.�c,��c. Q,�. �\�aS "� �S?��s,, � Certified Tester(print) �o�Ce�b `�A,1LQ�'' Certified Tester(signature)_��Q,_ Firm Phone#�Z1�'3N�j- 2221 Cert.TesterNagl�(�ll��Q3 Date ��2�1�w11 *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 I 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�iC.�. ��-�.1 �, CONTACT PERSON/PHONE: U� C-��-C.,, LOCATION OF SERV ICE: �1� �F'i��s��Y� 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 �ouble Check Valve `I Double Check-Detector ❑PressureVacuumBreaker �liSpill-Resistant Pressure Vacuum Breaker Manufacturer�js� Model Number��YY1\(3'T- Size �41 Located At �cn�- b✓�`Tc;Yr� ��m Serial Number �3�i�2,"� Is the assembly installed in accordance with manufacturer 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 Tightl� Closed Tight I� psid psid psid '� Leaked❑ Leaked�,� Did not open ❑ Did not open f� Leaked�l Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Ciosed Tight f 7 Closed Tight� psid psid psid Test gauge used:Make/Model rniC�-�)dS��T S=�a��Z-� SN: ['�3\�132��1 Date Tested for Accuracy: � /'1�Zt�\�1 Remarks: The above is certified to be true at the time of testing. FirmName�erir. ��'�%ttrh;;n wv� Firm Address 10 '�S Vt<�r,,,�c�,IL .�� -\\q� .�11 15��°Z, Certified Tester(print)�,,c,-ih��(�✓ Certified Tester(signature) Firm Phone#'Z1�-1��1�( '2�.2� Cert.Tester No.�Q�1�3��j Date ��2`�1 I ZOl"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: � CONTACT PERSON/PHONE• �,;q �jl y �� LOCATION OF SERVICE: �1� �c�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 ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector L9�oubleCheckValve �Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �a S Model Number aC�1 1(Y�1�.T Size Z� Located At ��,rik- a�� Serial Number �Ut" �,�7►b�.� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �LS 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 1•'Z psid Held at \.�O psid Opened at Opened at Held at Initial Test Closed TightC� Closed Tight :� psid psid psid �S Leaked❑ Leaked'�l Did not open ' Did not open J Leaked�-1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight.-1 Closed Tight n psid psid psid Test gauge used:Make/Model 1� ►��'�r��S�1�?�1S -cj`1X's�-Gl SN: (�� 2�'t� Date Tested for Accuracy: 1-� �� ZU 1�1 Remarks: The above is certified to be true at the time of testing. Firm Name/�YY\Gi�'►(.Gx� >�^��2�h'n C'121DFirm A ddress �C 1�`,1�i�G. �c��k ��_ �C��t�,1� 152�� Certified Tester(print)��,�ct,e�c�1[�.,� Certified Tester(signature) Firtn Phone#�Z(L}-�� -22�-� Cert.Tester No.��(�� Date � ��l� * 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