The URL can be used to link to this page

2017_1031 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: � ' LOCATION OF SERVICE: �a �eLI ! �mp� 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 ❑DoubleCheckValve �Double Check-Detector i�lPressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker �-- !�i Manufacturer �Q Model Number 9� q� / Size Located At �� /Q�Z�-- Serial Number �Q�J~G r Is the assembly installed in accordance with manufacturer recommendations andlor local codes? ��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�psid Held at psid Opened at�, Z Opened at Held at Initial Test Closed Tight� Closed Tight ❑ 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�l Closed Tight❑ psid psid psid Test gauge used:Make/Model ��c �/rt.� `7`��"�� `r'SN: �� Date Tested for Accuracy: 9��/� Remarks: The above is certified to be true at the time of testing. FirmName ' �� Firm Address I�� a � `��• � �� Certified Tester(print) � �`� Certified Tester(signature) � � Firm Phone# �`t "�� '�'��-Td Cert.Tester No. F�r�� Date f� / � * 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 LD. #0570040 (Customer) �I MAILnvG aDD�ss: �3�3 Wrn� er �`,� �-O el, � CONTACT PERSON/PHONE: 'd i Z�y- � (o — b�f U LOCATION OF SERVICE: /�-� r t� C' I �� NDO� 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 ❑DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer (�l,.�L-f'i'S Model Number J�� Size ��Z r Located At (� °l-� 1M£�'_ +C�� Serial Number L T� �� 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 /l!� 1 st Check 2nd Check � � Held at��psid Held at ,��psid Opened at �� Opened at Held at Initial Test Closed Tight[�S' Closed Tight � psid psid psid Leaked❑ Leaked❑ id not open C I Did not open ❑ LeakedJ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight i l Closed Tight'� psid psid psid Test gauge used:Make/Model �r'! �f'Q�-� '7`�'�� SN: �v�� Date Tested for Accuracy: ��r�/7 Remarks: The above is certified to be true at the time of testing. Firm Name 'S Firm Address �� /�" � � �'t( Certified Tester(print) � c�1� � � Certified Tester(signature) � � Firm Phone# 2��f - �q� �� Cert.TesterNo. ��,,5^� Date �� l� *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: f�af?3 t�rCs►v�ct�Py l.%�r Lo�Pel I `�k CONTACT PERSON/PHONE: " 1''� -4 '`�C?`fb � LOCATION OF SERVICE: � 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 ❑DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer (�.�'�'�T� ModelNumber �� Size�_ Located At �� Z ��C� Serial Number �o `Z-( �Ob4� 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 '�•�psid Held at psid Opened at Z= � Opened at Held at Initial Test Closed TightG Closed Tight J psid psid psid Leaked-1 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'��7 psid psid psid Test gauge used: Make/Model �U'"t7�-� �`" z��K' SN: ��p Date Tested for Accuracy: g /1 /7 Remarks: The above is certified to be true at the time of testing. r- � % FirmName �DP�� S� Firm Address /�� ✓� � Certified Tester(print) � t,�� Certified Tester(signature) � Firm Phone# '2-�`T^�f 1� '"�� Cert.Tester No. #��7� 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: O3 11J ncx Ler C�� CONTACT PERSON/PHONE: ��i d 21�}— b �`�V LOCATION OFSERVICE: t�5 �� r�t�� e�l 1�i1 ��-�� 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 �DoubleCheckValve ❑Double Check-Detector ❑PressureVacuumBreaker �7Spi11-Resistant Pressure Vacuum Breaker Manufacturer �iJt�'t'TS Model Number �( m� Size ��`��' Located At W/�2 ZZ �t�l�.�� - Serial Number ZS�7 f� 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�_�psid Held at �psid Opened at�. � Opened at Held at Initial Test Closed TightFj� Closed Tight ❑ psid psid psid Leaked'i l Leaked�� Did not open ❑ Did not open �l Leaked�l Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair ClosedTight❑ ClosedTight n psid psid psid Test gauge used:Make/Model M.�►'a-CC� �{D�—Z�� SN: �.5�� Date Tested for Accuracy: � �I 7 Remarks: The above is certified to be true at the time of testing. FirmName �--�Pe�,� S S.� Firm Address � � EY� �r � �� , �� Certified Tester(print)� � � � Certified Tester(signature) � Firm Phone#��I�'—��p '�y� Cert.TesterNo. 1.�6�7�J' � Date �� 3j �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: 13�3 ��n � e'� � � � CONTACT PERSON/PHONE: ' i 2�`�' ��^ �b yV LOCATION OF SERVICE: -Gt vJ � �� ✓�' �� 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 Double Check Valve �l Double Check-Detector ❑PressureVacuumBreaker �lSpill-Resistant Pressure Vacuum Breaker / q � �, Manufacturer (.C,�'�"t S Model Number �.F �� 1 QT Size �� Located At �. .l� ma��/ Serial Number � ��Z� 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 �� psid Held at psid Opened at 3�L— Opened at Held at Initial Test Closed Tight�4� Closed Tight � psid psid psid Leaked i Leaked'.� Did not open J Did not open -I Leaked� Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight-1 psid psid psid Test gauge used:Make/Model ��a-� ��``�� SN: Z.s��Q'� Date Tested for Accuracy: ��/�/7 Remarks: The above is certified to be true at the time of testing. /-- �� a� ��- C�,� � ��I FirmName ��Aell 1�� Firm Address Q � � Certified Tester(print) t!i (�t.� � Certified Tester(signature) � Firm Phone# � T ' T��`�1�� Cert.Tester No. �� Date Id 3`l�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: 13D� iaSrarl, I�Y 1--�� C'� �1� �X CONTACT PERSON/PHONE: v+ ' Z 1`F —'�g b —�y'O LOCATION OF SERVICE: ��511 L�S, ctr � Cc�,fpe/I ` �'9 Sc�tAv J 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 �lReduced Pressure Principle-Detector ❑DoubleCheckValve ��Double Check-Detector !�iPressureVacuumBreaker C�Spill-Resistant Pressure Vacuum Breaker Manufacturer �0."�'�5 Model Number �.�Qb"`] m l [�Size �/Z Located At �� ie,� �'Y�Q,�er K i-�c,hEv'1 Serial Number � � J`�(�Z 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 �•Zpsid Held at psid Opened at Z�Ff Opened at Held at Initial Test Closed Tight!5F Closed Tight f:; psid psid psid Leaked'�l Leaked❑ Did not open � Did not open ��1 Leakedn Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight'�J psid psid psid Test gauge used: Make/Model l�y►'► /�raLv 'j�Q��-Q�%� SN: �S��C�OC� Date Tested for Accuracy: � �l�`� Remarks: The above is certified to be true at the time of testing. / /' � FirmName CbP��+ -��.� Firm Address 3� �'�'�n�'�'er �'• Certified Tester(print) �v�� ►��"J Certified Tester(signature) � � � Firm Phone# 2��"��0 r�U�� Cert.Tester No. ��Q�� 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) I MAILING ADDRESS: O rc� l �r � �I TX CONTACT PERSON/PHONE: � ` 2��{—�} lo — d�}O LOCATION OF SERVICE: I S`� C�, � ` �G/-�DOL 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 ❑DoubleCheckValve �-�Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �[!-Ft5 Model Number L�� Q'j Size �Z t� Located At C�S�Dr� Serial Number ��((D/:� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e5 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 at � psid Opened at 3• L Opened at Held at Initial Test Closed Tightf, Closed Tight � psid psid psid Leakedf�l Leaked�� Did not open �� Did not open ��:l Leaked�l Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight 7 Closed Tight C psid psid psid Test gauge used:Make/Model br�'�h/'uC-D ��r� 2'�� SN: Z��p Date Tested for Accuracy: T /7 Remarks: The above is certified to be true at the time of testing. FirmName �D � i� Firm Address �� '� 1� �t� Certified Tester(print) .iQV�d �� Certified Tester(signature) � � Firm Phone# 2/� -�f qG��Q`�'U ��7'v�g �� 3/ �7 Cert.Tester No. 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 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: 1303 �ra+r� 'er �2r � e�) `"� CONTACT PERSON/PHONE: Da.i�`d ��" G� Z i�-y �1lC7°`f b LOCATION OF SERVICE: �$� (�> �tr �� N r�4 5�-I�o� 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-Detectar ❑Double Check Valve ��Double Check-Detector �PressureVacuumBreaker ` 1Spi11-Resistant Pressure Vacuum Breaker g �� Manufacturer �a s Model Number 9� Size � Located At Q�An0.?:re- r��!' roc�r►'i Serial Number ��(o`t'7(p 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 �o�� psid Held at�psid Opened at �� Opened at Held at Initial Test Closed Tightl� Closed Tight �� psid psid psid Leaked❑ Leaked�J 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 Closed Tight❑ Closed Tight l-1 psid psid psid Test gauge used: Make/Model `om�JnxL� �a` �— SN: ��r�� Date Tested for Accuracy: Q�l��17 Remarks: The above is certified to be true at the time of testing. n �,` �__,,/ n. P�l FirmName 1�A,0�f� s s� Firm Address ��3 ��'�Lb'�7/� �-/�r. PP ./ , Certified Tester(print) � �� Certified Tester(signature) �J � Firm Phone# �� —`t'(�o ''��`fU Cert.Tester No. 7�J� Date �d 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 IRRIGATION DOMESTIC K� 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: ' � e�� CONTACT PERSON/PHONE: � � �t Z�u '4 "�v`{'v �` s LOCATION OF SERVICE: l � o- Ar�ar� '��°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 [�3Zeduced Pressure Principle i IReduced Pressure Principle-Detector ❑DoubleCheckValve �1Double Check-Detector rlPressureVacuumBreaker -1Spi11-Resistant Pressure Vacuum Breaker ' e '/ ,� Manufacturer w��'ICI rl S Model Number �S �z. Size lZ" Located At F�reAna L-or�c�SSi Dn Serial Number � �f7`��1(0� 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 � 1 st Check 2nd Check Held at�psid Held at?�'psid Opened at Jd Opened at Held at Initial Test Closed TightL� Closed Tight I�Y' psid psid psid Leaked��7 Leaked��:� Did not open L,� Did not open I i Leakedf } Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ ClosedTight�' I psid psid psid Test gauge used: Make/Model�� `�`-�� SN: Z��Q�3 Date Tested for Accuracy: q_'� l 7 Remarks: The above is certified to be true at the time of testing. FirmName�nf�-��-�—�J� Firm Address 13��Rkv`GI� �-ti' l�,�8�� Certified Tester(print) l�� i Certified Tester(signature) ��( � Firm Phone# �� -��.g8`F� Cert.Tester No. �4�� Date I� 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 K 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: 13d:3 �-J�r� '�.r' ��r � e-II �X CONTACT PERSON/PHONE: ctv;�f�o�� '�1 I`{'- �°I(o'��%`� LOCATION OF SERVICE: 1�5 c�3 ��icwa.� ��i� ��h 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 ❑Reduced Pressure Principle-Detector f�Double Check Valve CDouble Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer ��0 Model Number �S��C Size z,, Located At Fr0(��' O� gG�� Serial Number �� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? 7� 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 at 2.(o psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight 5�4 psid psid psid Leaked❑ LeakedC� Did not open ❑ Did not open n 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��'''�rucu '�0� Zp0 TK SN: ZS�O� Date Tested for Accuracy: 9 /��/7 Remarks: The above is certified to be true at the time of testing. FirmName �P�� Firm Address j�� 'er ��• � ec� � Certified Tester(print) ✓►� �!� Certified Tester(signature) � Firm Phone# �� "'7 Q�'�� Cert.Tester No. T��7c7� 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