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2017_0626 IRRIGATtON 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: �3�3 G�t� le✓ �'r �� \X CONTACT PERSON/PHONE: Loui c.'aS Z� - `i(A'� �4D LOCATION OF SERVICE: b0 ,k+ '� l.n The backflow prevention assembly detailed below has been tested and maintained as required by coinmission regulations and is certified to be operating within acceptable parameters. � TYPE OF ASSEMBLY :✓Reduced Pressure Principle _1Reduced Pressure Principle-Detector � IDoubleCheckValve iDoubleCheck-Detector i 1 pressure Vacuum Breaker -�Spill-Resistant Pressure Vacuum Breaker Manufacturer �4'�'�s Model Number �.-F � Q� Size Located At hi�-�c��►1 Serial Number 'J�(� 3�v Is the assembly installed in accordance with manufacturer recommendations and/or local codes? 1�'S Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve � 1 st Check 2nd Check �d,Ss Held at�psid Held at psid Opened at 3�� Opened at Held at Initial Test Closed Tight'i i Closed Tight � I psid psid psid Leakedl I Leakedl t Did not open I Did not open I Leaked , Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight' i ClosedTight I psid psid psid Test gauge used: Make/Model `„-o'"''�� Q'��Tr� SN: 'Z5��Q Date Tested for Accuracy: �l �� !�o Remarks: The above is certified to be true at the time of testing. - �� G� �� FirmName �pY'�� S� Firm Address t�0� Et/ v' Certitied Tester(prant) �V iGl i Certified Tester(signature) �� Firm Phone# ��-��"�4� Cert.Tester No. UCC��g Date �r �5^� ( * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT 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) MAILINGADDRESS: j.3t�� /�'/'I �� . � �� '� CONTACT PERSON/PHONE: D ' Zl�I-�{ (o -`}�U�-f0 LOCATION OF SERVICE: D � ' 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 �teduced Pressure Principle ',-iReduced Pressure Principle-Detector � I Double Check Valve ' 'Double Check-Detector i IPressurc;VacuumBreaker -,Spill-Resistant Pressure Vacuum Breaker Manufacturer�JQTtS Model Number ��/�� Size ��, Located At�('�� Serial Number f7 b�v� I�3�- Is the assembly installed in accordance with manufacturer recommendations and/or local codes? CS Reduced Pressure Princi le Assembl Pressure Vacutnn Breaker Double Check Valve AssemUly Relief Valve Air Inlet Check Valve � 1 st Check 2nd Check Held at ,( psid Held at psid Opened at'��d Opened at Held at Initial Test Closed Tight�• i Closed Tight � I psid psid psid �Ct55 Leaked I Leaked( I Did not open i Did not open ' Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight' ! ClosedTight I psid psid psid Test gauge used: Make/Model l..�M�-Lr� �f��- ?--��L SN: ZS�.�>C� Date Tested for Accuracy: __ ��!��/(e Remarks: The above is certified to be true at the time of testing. Firm Name�pP�l� -LS� Firm Address (�?3 ��U.�L �V �`r � e�l Certified Tester(pr�nr) ` �' 1 Certified Tester(signature) � � Firm Phone# z��"�q�`��d Cert.TesterNa �f�,�(�'7� Date Co'-�'r`�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT PARTS White-City Copy Yel(ow-Customer Copy Pink-Tester's Copy IRRIGATION DOMESTIC � FIRELINE The following form must be completed for each assemb(y 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: I��3 1� `r' � �II�X CONTACT PERSON/PHONE: I�- i z-��I--�-! b- �p LOCATION OF SERVICE: oUc'n j �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 xlReduced Pressure Principle -!Reduced Pressure Principle-Detector IDoubleCheckValve ;Double Check-Detector ' IPressureVacuumBreaker 1Spi11-Resistant Pressure Vacuum Breaker q � �i Manufacturer �Gt�-t9 Model Number /��1 Size ��Z Located At G7d� HiG}l.L Serial Number '7�j�`7�'j 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 pp.Sh Held at�psid Held at psid Opened at Z� 7 Opened at Held at Initial Test C►osed Tight( i Closed Tight I ! psid psid psid Leakedl I Leakedl I Did not open : I Did not open Leaked I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair CiosedTight' ! ClosedTight I psid psid psid Test gauge used: Make/Model �M/J%ttC c� '�� -�� SN: 2��fL'�O� Date Tested for Accuracy: _��5'//�0 Remarks: The above is certified to be true at the time of testing. /1 / �� , I , Firm Name (�pT�O"e�! ,� .�D Firm Address ��J GJ/' � , Certitied Tester(prinr)�Ul� c�'e Certified Tester(signature) , � � /' ��, / �f Firm Phone# Zr�-�S�� Cert.Tester No.� �7� Date 10'f �i �7 * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT 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 recordlceeping purposes: � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) n , MAILING ADDRESS: l 3 l.-, �'« [�C` CONTACT PERSON/PHONE: Z��l-4 G� -- 'O�fo LOCATION OF SERVICE: C' 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 '-,Redeiced Pressure Principle-Detector � IDoubleCheckValve 'Double Check-Detector I Pressur�Vacuum Breaket• '�Spill-Resistant Pressure Vacuum Breaker � � " i� Manufacturer (�e7(1Tt'S Model Number__q�q/�'f � Size �� Located At �� 0 Serial Number �j��o� Is the assembly installed in accordance with manufacturer recommendations and/or local codes?__`��5 Reduced Pressure Princi le Assembl Pressure Vacuum Breaker Double Check Valve Assembly Relief Valve Air Inlet Check Valve � l st Check 2nd Check Held at �� psid Held at psid Opened at Z;(�. Opened at Held at Initial Test Closed Tight� i Closed Tight � I psid psid psid Leaked� I Leaked� i 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' i ClosedTight ! psid psid psid Test gauge used: Make/Model�-t��''1'l�71t1GC? ��'�Z�'�G-- SN: _ 'L.�j�Sa(7� Date Tested for Accuracy: �I I�� Remarks: The above is certified to be true at the time of testing. Firm Name t..p�fJ�� 7� Firm Address 3Cd �'' �-11Y'. Certified Tester(prinr) ` � C,' Certified Tester(signature) L ` � p� / Firm Phone# ��- ��C7�� Cert.Tester No. 1.�1'�� l�jg Date �P��-�� * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS **USE ONLY MANUFACTURER'S REFLACEMENT PARTS White-City Copy Yellow-Customer Copy Pink-Tester's Copy