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2017_0713 �. 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: ' � !fJ ItA� ��I�� cz�t'E.S". .5ro7�l CONTACT PERSON/PHONE: ` 1 ` ' l��*/� 1 - 'Z �.�!`a� LOCATION OF SERVICE: � The backflow prevention assembly detailed below has been tested and maintained as required by commission regu(ations and is certified to be operating within acceptable parameters. TYPE OF ASSEMBLY �r]Reduced Pressure Principle �C��duced Pressure Principle-Detector ❑Double Check Valve Ti�!'Double Check-Detector C1PressureVacuumBreaker I �Spill-Resistant Pressure Vacuum Breaker Manufacturer �,L'� Model Number ��y��}' Size ��_ Located At -�N �v�- ,�1 y S��ec[ � Serial Number ��Qa�� 7 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 d Held at�psi Opened at Opened at Held at Initial Test Closed Tight� Closed Tight ��_ psid psid psid pQ�� Leaked'-''� Leakedr; Did not open '=1 Did not open 'I Leakedi 1 Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight[l Closed Tight�I psid psid psid Test gauge used:Make/Model�G/�D ��`��a �'�� SN: Qrr�r�q6 Date Tested for Accuracy: ��3/- /(o Remarks: ��n Q.• The above is certified to be true at the time of testing. Firm Name �s �,�%�+��S�'c�Q S�J� Firm Address o`ZbOd/1�=1'`i�u��'Q ��►-� ?��Y/ Cerrified Tester(print) dwtFr�� 6��.. Certified Tester(signature) Firm Phone# ��'`�^��l�'�1«� Cert.Tester No.��oC��'C"C/�j/ Date ?�i=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� 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: � �K� I� M c��i ��-��j�� l��`�� .SitO/ CONTACT PERSON/PHONE: ,' ' t � �3 LOCATION OF SERVICE: oZ 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 �I� duced Pressure Principle 7Reduced Pressure Principle-Detector oubleCheckValve '�Double Check-Detector ❑PressureVacuumBreaker '�Spill-Resistant Pressure Vacuum Breaker Manufacturer I��-"� Model Number Dt1T/,Q�3 Size Located At ,� ►�� .,c.c�l�` b ��'/'�f% Serial Number�/!�lt�� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? t'.f 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 Held at�psi Opened at Opened at Held at Initial Test Closed Tight� Closed Tight �� psid psid psid ��S Leake�d�� Leaked�� Did not open �� Did not open i ] LeakedCl pairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTighti�l ClosedTight'��i psid psid psid Test gauge used: Make/Model �p��Q y��-�°�"1TIC'.�(�J SN: Q l�f 1�g� Date Tested for Accuracy: �-z3�' {�a Remarks:r1,D i1.� The above is certified to be true at the time of testing. Firm Name p S� F=71L G�"��-�/�GFirm Addres .,. �OG�� /�i.vNaf�1Ctl.t� Ca�i��-s�'yl Certified Tester(print) luft,f<ed 6 om�i Certified Tester(signature)�,�... Firm Phone#�1`j 3y/�7��a Cert.Tester No.b�C�Q��9�/ Date 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 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: � 4�C' �;21 a� /��-I�'1�/�"�1�'''�- 'J�a nC��I�tS 7�S�J/ CONTACT PERSON/PHONE: ��+ �LS�i7 ! - " " �� LOCATION OF SERVICE: //� � CI 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 ❑Ij�educed Pressure Principle �Reduced Pressure Principle-Detector p�DoubleCheckValve �Double Check-Detector ❑PressureVacuumBreaker �lSpill-Resistant Pressure Vacuum Breaker .� Manufacturer Lt��'�S Model Number L7�7%r1/ Size� Located At /Il��/' °t��ne,iP ��J� �'�� Serial Number�� 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�psi Held at.�� psi Opened at Opened at Held at Initial Test Closed Tightl � Closed Tight !� psid psid psid S' Leaked'�7 Leaked�� Did not open f 7 Did not open :� Leakedf� 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 s��a ��'��"�j��(.� SN: �l//II�l� Date Tested for Accuracy: �'�-,�i"'L�f1 Remarks: M1 p/lC�, The above is certified to be true at the time of testing. Firm Name �SS ��P�C�9�a.��,.�JC., Firm Address 6.��0.;� /��.�+c.� !"/aL.� �^j�''*ct 7-�� / Certified Tester(print) Wtt�R�O �aM�L Certified Tester(signature Firm Phone# 02�`��_3 y�?1�c� Cert.Tester No,��D ��_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 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: GL;�g .�i �� i�n�r�, ��e�7a� p� c,s' /f��/ CONTACT PERSON/PHONE: " A — �- �e(Q LOCATION OF SERVICE: //�2aZ �/ , 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 ❑I�duced Pressure Principle i:Reduced Pressure Principle-Detector Lq'f�ouble Check Valve '-!Double Check-Detectar I�PressureVacuumBreaker -ISpill-Resistant Pressure Vacuum Breaker �/ �i Manufacturer��j Model Number 8�� Size �72 Located At V1�-�'��-' �� b y �1f�'C�h c'e Serial Number ��0��' 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�d Held at ��9 psi Opened at Opened at Held at Initial Test Closed Tighti� Closed Tight psid psid psid s Leaked'�1 Leaked❑ Did not open � Did not open �l Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Ciosed Tight C7 Closed Tight J psid psid psid Test gauge used:Make/Model��' yd�OC�~��1�l� SN:_(�fl��`l�/� Date Tested for Accuracy: g"� �'�� Remarks: !'�C/l.t, The above is certified to be true at the time of testing. FirmName �.� ��^��,-�� Firm Address��d� /)r�-�� /l�t�� t�`�� 'j�'d�l/ Certified Tester(print) ',NilFn=' 60�+'��Z Certified Tester(signatu , � � Firm Phone#�f y^�`��"7/l�' Cert.Tester No. ,R,�pQEal�tl 9'�/ Date `�/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