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2017_0605 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: : 6 S Y � � v� 01� CONTACT PERSON/PHONE. � - � � � LOCATION OF SERVICE: ��(��,Ul��S irJ�t-'� Lu • 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 ASSEMSLY ❑}�educed Pressure Principle ❑Reduced Pressure Principle-Detector '�Double Check Valve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker < Manufacturer �LbL� ModelNumber ��v Size � Located At f�� - U-f 1r`�'� Serial Number ;�Y/��/ Is the assembly installed in accordance with manufacturer recommendations and/or 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�p id Held at .�D ps�d Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid PC�S s 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�t�i l v y� �D U J HC,SU SN: Q{/!l/9!� Date Tested far Accuracy: �'�3/'��' Remarks: /1o�°t�.� The above is certified to be true at the time of testing. F irm Name (�,�;,��.r��k;t,►N�.�Y`�G� Firm A ddress��t e�-+�� U�`�^''��1�•''�sv�� Certified Tester(print) {I��►''� G�f�'�P 2 Certified Tester(signatur�"�� Firm Phone# ��-�`I�`'�]1�}C� Cert.Tester No.l��Q�3 d�i'-f Date �"�7�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 ( �j�fl�" ' tYSS��;'s' ��'��f(vd � U 11� �,��'I�1 MAILING ADDRESS: ' '�rn '�^� CONTACT PERSON/PHONE � u.r � — ' b LOCATION OF SERVICE: t `� rt ` aEc.�'� 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 �❑ duced Pressure Principle ❑Reduced Pressure Principle-Detector oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker i� Manufacturer ��'�S Model Number 9�SD�� Size 3%y Located At �Vu f��E c.� d��- ►� �t�- Serial Number 3 8 aZ 9 y'1,� Is the assembly installed in accardance 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��id Held at�•g psi Opened at Opened at Held at Initial Test Closed Ti ht Closed Ti ht psid psid psid Q�t c55 Leaked❑ Leaked❑ id not open ❑ Did not open ❑ Leaked❑ Repairs� Materials Used Held at psid Held at psid Test After Opened at Opened at Held at a Repair ClosedTight❑ ClosedTight❑ psid psid psid i1 f Test gauge used:Make/Model!��'�� `�� a0� r�� SN: 4ll j/1��o Date Tested for Accuracy: p`3! '�� Remarks:�l-�,'le • The above is certified to be true at the time of testing. FirmName p�5 t'�K��'�y��-��' Firm Address �60� /�a-f�� f d��c�e �u�'Ic+�l.�(�SG�f Certified Tester(print)WiLFR� C?B��Z Certified Tester(signature) *'r� � Firm Phone# �I j-l-��l�=`11�v Cert.Tester No.�AC��3�9�/ 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 DOf�1E�TiC 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 ASSEiVIBLY TEST AND iV1AINTENA:�iCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: ' � �= 1? ' '�5� I�u-��d'S 1.�� D %1�.`7�ly CONTACT PERSON/PHO '�n �4 ! - ' b/ LOCATION OF SERVICE: . D �.�'S /' 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 ❑ educed Pressure Principle-Detectar ❑Double Check Valve �ouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker :i Manufacturer ��1 K�n 5 Model Number�� 5� p� Size � Located At N��''�"�'1 5 wi� p"� �Id4 �� '��' Seria1 Number N..3 7'�la 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 Held at ��p id Held at�`�psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid ��5 Leaked❑ Leaked❑ id not open ❑ Did not open ❑ Leaked❑ Repairs%' Materials Used Held at psid Held at psid Test After Opened at Opened at Held at J Repair ClosedTight❑ ClosedTight❑ psid psid psid r, !'r � Test gauge used:Make/Model �Qcl�o �/D�,2v� �T"lc�� srr: i�i�� i ��i� � Date Tested for Accuracy: � ,3 I�I b Remarks: ��ne . The above is certified to be true at the time of testing. FirmName p�$ �%'e,�i�c��^G� .j..h1� � Firm Address ;�;Z�d.i /1��:t/vn�( Il�lr.�[� �u-r��f�rlS�N/ Certified Tester(print) ��L�R� �oM�'L Certified Tester(signature)�i� Firm Phone#�l�/-3`1l `'��'� Cert.TesterN�.+PJP60�3D�!'-� Date � ^�� l� * TEST RECORDS�IliST BE ILEPT FOR AT LEA�T THR�E �"E��S **USE ONLY NIANUFACTURER'S REPLACE�IENT PART'S White-City Copy Yellow- Customer Copy Pink-Tester's Copy IRRIGATIOiV DO�iIESTIC F1RELlNE � 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 ASSENIBLY TEST AND NIAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: � � � reSS t' 1�� C 1 .��l�j CONTACT PERSON/PHONE: ► - LOCATION OF SERVICE: a `� �y • The backflow prevention assembly detailed below has been tested and maiatained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSENIBLY �❑ educed Pressure Principle ❑Reduced Pressure Principle-Detector ouble Check Valve CDouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer i/�1a'�$ Model Number OD'1/rl3 Size ��_ Located At cl��S►L� � ��d�; i n �'�v� Seria1 Number a �I q,S�J. Is the assembly installed in accordance with manufacturer recommendations and/or local codes? eS� 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�p id Held at�_ps Opened at Opened at Held at Initial Test Closed Tight� Closed Tight � psid psid psid Ctsrj Leaked❑ Leaked❑ id not open ❑ Did not open 0 Leaked❑ Repairs% Materials Used Held at psid Held at psid Test After Opened at Opened at Held at i, Repair Closed Tight❑ Closed Tight❑ psid psid psid ;i <` Test gauge used:Make/Nlodel.��IO �/�:�� TK„S�� SN: �/l�ll�� Date Tested for Accuracy: �-��( '�� Remarks: IL��12, � The above is certified to be true at the time of testing. Firm Name p�s 1-��GJd��{ Sr�� Firm Address �6flJ�/I��ier��a�� Cc�l'li�,�r�, �1 SU��II Certified Tester{print)IA�i�F!'�� (�j6 rnN Z Certified Tester(signature j� Firm Phone#�1�/�-.� yl" 71 D0 Cert.TesterNo.�Qf)f}I�D�i'7� Date �"��'17 _ * TEST RECORDS ti1tiST BE KEPT FOR�T LEAST THR:E�"E.=�RS **USE ONLY VIAt�tIJF'ACTURER'S REPLACEI�IENT Pr1RTS 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 ASSE�IBLY TEST AND NIAINTENANCE REPORT NA��IE OF PWS: CITY OF COPPELL PWS I.D. # 0570040 (Customer) MAILING ADDRESS: t l in �` � ,• S ' � L��.�/blJ ' �1C•'1:�0 f� CONTACT PERSON/PHONE: �. �,�s=-�ti - ' LOCATION OF SERVICE: 1 8 �� - 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 ASSE�IBLY �❑ educed Pressure Principle ❑Reduced Pressure Principle-Detector oubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �� Model Number �,�L� Size ��_ Located At �� .f?l�r�.�P ��°1 �L'-✓�'�' Seria1 Number 6 � � Is the assembly installed in accordance with manufacturer recommendations and/or local codes? c'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�� p,�id Held at'�ps' Opened at Opened at Held at Initial Test Closed Ti htf Closed Ti ht psid psid psid Ct��a LeakedJ Leaked❑ id 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,��.1t�/j� yo-a�v�TKS�� SN:O J��I 4�(� Date Tested for Accuracy: �';3)'��' Remarks: �-D►'1�°. The above is certified to be true at the time of testing. FirmName p 3 s �'��i�n�L� Firm Address o��/Uaf�•� /'1�� G�+`��,�7su��1 � Certified Tester(print)�`��f(d� (°��/r't�Z Certified Tester(sianature)� Firm Phone# ,��'-1"<3`t( "'�I�� Cert.Tester No.�Pf�p 1�aR�,l Da�e ��s�l 1 * TEST RE�'ORDS i�IUST BE KEPT FOR AT LEAST THREE YE�t2S **USE ONLY NIANUFACTURER'S REPLACEVTENT Pf1RTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy IRRIGATION DOVlEST1C FIRELINE � The following form must be completed for each assembly tested. A signed and dated ariginal must be submitted to the public water supplier for recordkeeping purposes: BACKFLOW PREVENTION ASSEMBLY TEST AND i�L�INTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) �t , MAILING ADDRESS: i i� � rl�� %� �Nd G .55 u,�:.��5 �h�� !60 � �� X'�SZ'!`% CONTACT PERSON/PHONE: +� � � � ' �� LOCATION OF SERVICE: _?�'10� Ctip'eS5 t�r.��ifS �iL-�c� The backflow prevention assembly detailed below has been tested and mai�tained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF ASSEIVIBLY ❑Reduced Pressure Principle ❑ educed Pressure Principle-Detectar ❑DoubleCheckValve �ouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker ti Manufacturer 1/��.� Model Number�]J � �C�� Size (o Located At /1��►^'{��'�f �� b�� t�n �fc��+"� Serial Number �f'/�%�6"� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? C 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� p�id Held at��psi Opened at Opened at Held at Inifial Test Closed Tight�� Closed Tight psid psid psid �s's Leaked❑ Leaked❑ id not open ❑ Did not open ❑ Leaked� Repairs% Materials Used Held at psid Held at psid Test After Opened at Opened at Held at i, Repair ClosedTight'�; ClosedTight� psid psid psid >� �` Test gauge used:Nlake/Mode1,A� d7 D -�-D� � 1 SN: ��/l//c(� Date Tested for Accuracy: l� Remarks: (ln�� The above is certified to be true at the time of testing. FirmName�� 1'�`f`��J�"�r ��L` FirmAddresso��iC;,� /��`h`"`P`t /Ili«' ��r�'`z� ��'`�� ;�.. � �_ Certified Tcster(print)VJ F�� ?+'��Z Certified Tcstcr(signature FirmPhone� �I�-/-�j'-1� �7�� Cert.TesterNo�PC�Gf��1� Date �`�� 7 'K TEST RECORDS tiit;ST BE KEPT FOR AT LEAST THREE��_-�RS **USE ONLY NI�vUFACTURER'S REPLACEMENT Pf1RTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy