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2017_0523 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 P�WS LD. #0570040 (Customer) MAILING ADDRESS: G g D S RO V fi L L N CONTACT PERSON/PHONE: ST EPNAN,I'F L ONG y 6 9 -a�13 - �'//�S LOCATION OF SERVICE: (0�0 S /QOVAL 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 ❑�educed Pressure Principle I�Reduced Pressure Principle-Detector ��oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker L',Spill-Resistant Pressure Vacuum Breaker Manufacturer �iv/¢TTS Model Number ��rl I'�I.Z Size o� �� p�l SrdE oF r3�D�, 4�/ S. Located At ��/AL US/. A/EXT 10 ►/R�J L T Serial Number /0 0 7' �d Is the assembly installed in accordance with manufacturer recommendations and/or local codes? e 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 a:3 ps,'�d Held at a..� psi Opened at Opened at Held at Initial Test Closed TightS�� Closed Tight 1.-� 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 Opened at Held at Repair Closed Tight C� Closed Tight� psid psid psid Test gauge used: Make/Model �1"Le�.L'/IlS T�s-5 sN: D �l/I/ 9 5 b Date Tested for Accuracy: L/-o��-/ 7 Remarks: The above is certified to be true at the time of testing. FirmName �oET7ER ��RE Firm Address /b35/ OLYMAlC DR. DALLAS .TX Certified Tester(print) �ARY lJLO�/�/�Certified Tester(signature) i'��l/ Firm Phone# o�/y�,35�' .3�93 Cert.TesterNo. QP d0/�SJ� Date 5��3-/ � * 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 I.D. #0570040 (Customer) / MAILING ADDRESS: �0 8� S• R 6 V R L _N coNTacT PERsoN�PN�NF� ST EDNA�E �ol►�G - y�9_ �9� - y/8 5 LOCATION OF SERVICE: �p80 5 ROVAL LN 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 �Reduced Pressure Principle-Detector ouble Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker i�Spill-Resistant Pressure Vacuum Breaker Manufacturer �.C�/�TTS Model Number �O 'I/'�2 Size� aN ST DE a F �BLU G� ON S. Located At ROyAL LN NEXT' T� V/iULT Serial Number 9 9 9 9 O Is the assembly installed in accordance with manufacturer recommendations and/or local codes? y�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 ato�.y p Held at oZ•o? ps� Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid Leaked; ' LeakedC' Did not open � ! Did not open ❑ LeakedC; Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ ClosedTight❑ psid psid psid Test gauge used:Make/Model��rL/F.ZNS T�s'-5 sN: a y//19 S 6 Date Tested for Accuracy: y o�0 -/7 Remarks: The above is certified to be true at the time of testing. FirmName �oETTE'R �Z'�E Firm Address /03S/ OLYI'�P.IC DR. D/9LL/9S� jX Certified Tester(print)�/�/�Z Y (,TLO VLr2 Certified Tester(signature) � �G/� Firm Phone#�7/�/-3 5 8�35 9 3 Cert.Tester No.�P d0//S 7 0� Date ��a 3—!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 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 recardkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) L� MAIL��aDD�ss: 6�a s Ro v/�� . CONTACT PERSON/PHONE: ST�Pki4 N..tE L ONG " yG� - o?93-y�85 LOCATION OF SERVICE: ��D 5, RO I�AL L 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 CReduced Pressure Principle-Detector ❑DoubleCheckValve '�ouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker � �i Manufacturer �/9TT5 ModelNumber ?9Yx L�CQA Size oN sro� oF Qc.oG, oN s. Located At ROY�9 L LA�I� T N 1/A tJL T Serial Number�0 0 3 0 g Is the assembly installed in accordance with manufacturer recommendations andlor local codes? y�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 O7.y psid Held at�psi Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid � psid psid Leaked�� Leaked�� Did not open � Did not open I� LeakedC� 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 �rL/�t/V$ T�r- S SN: d y/�/ 9��o Date Tested for Accuracy: y'0�0'/7 Remarks: The above is certified to be true at the time of testing. Firm Name��'TTE� �IRE Firm A ddress /b 35/ o�yMP�G �R �AALL_AS TX Certified Tester(print)�AR I� �G OtJ�R Certified Tester(signature) i�� Firm Phone#o7/y-358-3593 Cert.Tester No.BP ��57a 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 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 LD. # 0570040 (Customer) MAILING ADDRESS: l0 80 s. � f9L L CONTACT rERSON/rHONE• STE�/-�A r E L�Nls ' �/G�" a 9.3 � y S LOCATION OF SERVICE: �D 8D �,�{oYAL LN 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 �C! educed Pressure Principle ��Reduced Pressure Principle-Detector ouble Check Valve '-7Double Check-Detector ClPressureVacuumBreaker C1Spi11-Resistant Pressure Vacuum Breaker 3/� ,� Manufacturer �i9 TTS Model Number �D l M T� Size QN S�UE oF jiLDG, ON S. Located At RO VAL L ANLt -.ZN Vi9�/L T Serial Number y�$.3/ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? y�S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve 1 st Check 2nd Check Held at.`�.a psid Held at e�.� psi Opened at Opened at Held at Initial Test Closed Tightl� Closed Tight � psid psid psid Leaked'�-� Leaked�7 Did not open C Did not open �'� Leaked'_1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight[1 ClosedTight`� psid psid psid Test gauge used:Make/Model GvlLiftNS ��s-.� SN: ��//// 9.5� Date Tested for Accuracy: y� o?p-/�J`' Remarks: 'i�,�.L s �S TiS�E �SS 6N 7y� AC�/�LDGc/ The above is certified to be true at the time of testing. FirmNameXOETT�E/i �'IRE Firm Address /�3.�/ 4L YMP�'C OR - /,�AL Li9$; Tjf Certified Tester(print) (�i9/Q y �GO I�E/7 Certified Tester(signature) � � Firm Phone#e?!5/-3S f�- 35�3 Cert.TesterNo.Qp Q'�l/S7a? Date �-�?3-/'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 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) MAILr1vG ADD�SS: �D S A N CONTACT PERSON/rHONE•��'��A .�E LIN(� ' yG�' �93-y/ LOCATION OF SERVICE: �' �O S. RO�iAL LN 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 �'7Reduced Pressure Principle �iReduced Pressure Principle-Detector ❑DoubleCheckValve 6Y�ouble Check-Detector �PressureVacuumBreaker ��7Spil1-Resistant Pressure Vacuum Breaker ii Manufacturer� R T TS Model Number ��y X b C D�9 Size�_ oNs=o� ofa�_g, oNs. Located At ROYALI�� -T N �7AUL T Serial Number /^d Ojl� '7 O Is the assembly installed in accordance with manufacturer recommendations and/or local codes? E 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 e�•� psi Held at •�•3 psi Opened at Opened at Held at Initial Test Closed Tight��.� Closed Tight C�, psid psid psid Leaked'.�' 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 n� Closed Tight i� ps�d psid psid Test gauge used: Make/Model ��t/�LK2NS T(s'S sN: a�,//1195� Date Tested for Accuracy: Y-�D��I Remarks: The above is certified to be true at the time of testing. Firm Name koE TrE R �T RE Firm A ddress d 35/ OG YP'j P'C - O�I G L S TX Certified Tester(print) ��R y (S[,0 UtiQ Certified Tester(signature)� �� Firm Phone#�/�/-,35 p -3 S 9 3 Cert.Tester No.QP 00!/5?� Date S�'�3"�� *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 LD. #0570040 (Customer) MAILING ADDRESS: �p SO S. �a YAc, L N CONTACT PERSON/PHONE: 5 � N F O/y(r — 9-� 43- 4/p.5 LOCATION OF SERVICE: (e �O S. / GV/�L LN 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 �r� duced Pressure Principle ❑Reduced Pressure Principle-Detector ouble Check Valve ��Double Check-Detector f-lPressureVacuumBreaker -ISpill-Resistant Pressure Vacuum Breaker Manufacturer �i�}TTS Model Number ? Size 3 � �� oN S.z�DF OF QLD�� ON S. 7 Located At RO y�L L N� SN Vi9!/G T Serial Number , �/ Is the assembly installed in accordance with manufacturer recommendations and/or local codes? ICS 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 a•oZ psid Held at a•d psi Opened at Opened at Held at Initial Test ClosedTightl� Closed Tight C psid psid psid Leaked��`.l Leaked�� Did not open -7 Did not open I�� Leaked�I Repairs/ Materials Used ' Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight C' Closed Tight��J psid psid psid Test gauge used: Make/Model �rLKI NS r�s'S sN: 0�,////9S G Date Tested for Accuracy: y�o10—/'7' Remarks: TFIE p��cA Ro .z�s ��VST�1� Ul�. Tr s /yARI� T �_ 1�' /`I/9�f� O!/'T" Ti�irE SFRIAL � 1� TN� /�I017&L -�. The above is certified to be true at the time of testing. FirmNameKOET�ER /�.ZRE Firm Address /�35! GLyI'�1!'.IC DR �-- �ALLAS TX Certified Tester(print) �y/�/eY CTGO UE.�Certified Tester(signature)� ��'�� Firm Phone#o?!y,3$Q-3543 Cert.TesterNo.�I�dDlJS,�� Date_ 5—�3�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