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2017_0426 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�.L-�/� V�� CONTACT PERSON/PHONE: 'n�.n rc,,,�-nr�� ____ LOCATION OF SERVICE: The backflow prevention assembly detailed below as 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 f�5oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer�� „�`C� Model Number L��l �M\ Size Z�` Located At Y��I �FY�t.G� @. �,�r Serial Number �cZl�lo3l.7 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 2�� psid Held at Z.0 psid Opened at Opened at Held at Inirial Test Closed TightC� Closed Tight C� psid psid psid � 55 Leaked❑ 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 Closed Tight❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model�(Y�� l�L�S-s SN:f�3�"1?,2�1 Date Tested for Accuracy: � �"1 � ��1 Remarks: The above is certified to be true at the time of testing. FirmName�CYvtC,�i��,�,�a}�.�S��Firm Addresslc��S ti'R ..Qc•�l?e�. '�1G5.'C�L1�23� Certified Tester(print)��,rQ,� Certified Tester(signature)_ �-�-�Z,— Firm Phone#2�U'�i4-2221 Cert.TesterNo.�C�\"��i?j Date �IZbI2U1�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 IRRI6ATION �� 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: '\7c,�1 �tl��i P� LOCATION OF SERVICE: �� Q� \�a 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 �oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer 1iU�� Model Number�C��M� Size Za Located At '��.1 5 ��- �. 't.��,.r Serial Number 7.10(01�(1 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? VGS 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�v psid Held at 2•0 psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid `��S Leaked❑ Leaked❑ Did not open � Did not open f 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 rn�(�`��}� ��-S SN: (�3�'►32a"1 Date Tested for Accuracy: t��"1 � 1� Remarks: The above is certified to be true at the time of testing. FirmName �mC►`►t�.� �1tL��ctcc„1��Firm AddresslL7S'1S U�1z,�-�c��1�i. C�\�.5.1��1523� Certified Tester(print)�rrtl�r�Y�.,r Certified Tester(signature) C�f►.�—. Firm Phone#�.�u-��-2221 Cert.TesterNo.�PUU1�1�4�j Date �IZIo�1�x1 * 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: 1�Ob 1�v�r'��r.c� CONTACT PERSON/PHONE:�o�n �i�i"1�r� LOCATION OF SERVICE: 7vK� Qoc.\-�. 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 A5SEMBLY ❑Reduced Pressure Principle ❑Reduced Pressure Principle-Detector C'�oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �tV0.�5 Model Number OU'1�M\G2T Size Z�� Located At �y 5�.�� 1.1��.� Serial Number }�Zldo3"� 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 r.b psid Held at�Z,psid Opened at Opened at Held at Initial Test Closed TightCJ� Closed Tight f� psid psid psid Leaked❑ LeakedC Did not open r 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��-�sk ��G''�S-S SN: O2,1"132��1 Date Tested for Accuracy: �f"1 � 1'� Remarks: The above is certified to be true at the time of testing. FirmName �1MiClC�,n�n�,,�cu�tc�iuv,Ei�c,;�Firm Address 1US�S1�\�17n`Pr��t�.�- �� 152�� Certified Tester(print)�rxcr��c,1�s� Certified Tester(signature) ��.— Firm Phone# Z�`�C"3"l9-2'Z21 Cert.Tester No.��U��3 Date �I2� I�r1 * 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: �OU �� i� �,nG� - CONTACT PERSON/PHONE: 17c.�n �ci ��'rnr� LOCATION OF SERVICE: The backflow prevention assembly detailed below as 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 GDouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer hX)..�5 Model Number �'1 Y`n \ Size Zt� Located At �a��1�r1 ��c�t.�. �. 'MkJt-�Gr Serial Number �Zlo�ZS 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 atl .ai psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight C� psid psid psid � Leaked❑ Leaked❑ Did not open I l Did not open ❑ LeakedCi 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(��-vL�tS1�� S SN: ��123�1 Date Tested for Accuracy: � �(�"1 �\1 Remarks: The above is certified to be true at the time of tesring. Firm Name�Vj��CGn�r.r,�r0 ctTLr1 rc u� Firm A ddress►�S�S V��k��ar�12d. 170.\�� "C�. '152�� Certified Tester(print)�C�e�i �.�CZ,i Certified Tester(signature) nc�ta,� Firm Phone#�\�-F-��J-ZZZ� Cert.Tester No. 1��00113Ci3 Date ��Z�.�21}1"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 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: �-}Ob 17�v�u�d CONTACT PERSON/PHONE:�a� C-��t�nt-,�� LOCATION OF SERVICE: 1�v�[.� 4�0�� 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 �1Reduced Pressure Principle ❑Reduced Pressure Principle-Detector :�ouble Check Valve �Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer�a't't5 Model Number �U1 �M 2 Size 2�� Located At NOY� �`f►c[� �i 'Mf�'t,r" Serial Number �'L1o1�(�� Is the assembly installed in accordance with manufacturer recommendations and/ar local codes? `I tS Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at2.•� psid Held at�psid Opened at Opened at Held at Initial Test Closed TightC� Closed Tight � psid psid psid Leaked� LeakedJ Did not open ��l Did not open ❑ Leakedn Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight i_7 psid psid psid Test gauge used:Make/Model m\�-�tv�S�' I �O`'t S 'S sN:b311�Z�i'1 Date Tested for Accuracy: � �(�'1 � 1, Remarks: The above is certified to be true at the time of testing. FirmName �YY�2j►y�,�n�1r�t,�Rr'tut�t�E%,uv� Firm Address�uS��1�5h,.��tk.�Zri QC.1�� 1523� Certified Tester(print)��Zr� }�j�,,�Le✓ Certified Tester(signature) Firm Phone#�Z�� -��-2221 Cert.TesterNo.��OG113�13 Date ��Zlc�ZOt1 *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: 1�' Cj_�'�� D n d CONTACT PERSON/PHONE: 'nav� rn �t►��w LOCATION OF SERVICE: '� U�C.e. a�i�a 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 �oubleCheckValve CDouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer Wo..{�S Model Number'1�lutOG'D 1� Size \Z�� Located At ��-�h Vow1}- Serial Number 1VUZ\3 \\O�1 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ��tS Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly • Relief Valve Air Inlet Check Valve lst Check 2nd Check Held at 3:� psid Held at��psid Opened at Opened at Held at Initial Test Closed Tight'� Closed Tight C� psid psid psid ��.55 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❑ Closed Tight❑ psid psid psid Test gauge used:Make/Model�l �c�-Vve.��`t��S-S SN: �31�1�2��1 Date Tested for Accuracy: � �"1�'"1 Remarks: The above is certified to be true at the time of testing. FirmName�nnW�; c.,n}t�,r,��,a,rr.��('�_yTFirm Address 1(�S"� V�{�k�.r�Y-�`. 17c.\�5 'TX �1523°G Certified Tester(print) ��yr Certified Tester(signature) ��i��— FirmPhone#"�\y'3`-�"i-222� Cert.TesterNo.�V�C�l�j`�?j Date �-��21c�2C�11 * 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: l�pb C?«��nc�cc CONTACT PERSON/PHONE: ��rrn Cn��n¢. LOCATION OF SERVICE: � The backflow prevention assembly detailed below as 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 C�ouble Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker i�Spill-Resistant Pressure Vaeuum Breaker Manufacturer �0�,}}S Model Number (�p`1 Y�Z Size � �" Located At �,b�t1�n�/c�s�1� Serial Number 11S�110 Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �I�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 1•� psid Held at Z..Z psid Opened at Opened at Held at Initial Test Closed Tight4Y Closed Tight I� psid psid psid '7 Leaked�7 LeakedV' 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_��C�-�v�s� '�)yS�-� SN: b3►13 Z�i1 Date Tested for Accuracy: 1� � '1 � \'1 Remarks: The above is certified to be true at the time of testing. Firm Name n��r��,�-r��h,N,F��Firm Address �L�S�1S Y��.�oY�4�.,1_ �\�y�"�. �IS23� Certified Tester(print)�c,c.c,r,�,�-,r Certified Tester(signature) Firm Phone#��Ii-1-3�`Z-Z'Z21 Cert.Tester No.��OU�`��j�3 Date 1��Z�v �?�,�� * 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