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2017_1030 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) n MAILING ADDRESS: t�jv 3 �ran I�` l.i r � e� �� CONTACT PERSON/PHONE: � LOCATION OF SERVICE: �Zc� �c.lties i r��.� 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 ��7Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker Manufacturer �['t'�S Model Number bDT/►'1 I Q� Size Z�� Located At C�Rm��e.�� - C� Serial Number .55��Z� 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 2'� psid Held at ��7 psid Opened at Opened at Held at Initial Test Closed Tightl� Closed Tight +�14, psid psid psid LeakedCi Leaked� Did not open !�� Did not open � Leaked�r l 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/Modell�vr+��Co � Q-.�� SN: 2�'SD� Date Tested for Accuracy: � /� Remarks: The above is certified to be true at the time of testing. Firm Name �/L��c� y�� Firm A ddress -30� ��n l�` �►'• � �� , , �� ' Certified Tester(print) U� Certified Tester(signature) � Firm Phone# �`1 -�g� �0"7� Cert.Tester Na O(��SS Date /Q �p �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 COPPEI�L PWS I.D. #0570040 (Customer) MAILING ADDRESS: 130 �+-�ra �►' � 'e� �_ CONTACT PERSON/PHONE: ' � �Z- �y '4 b � a 40 LOCATION OF SERVICE: I � a-4-c.1.e� fo.[.� 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 �ouble Check Valve i�Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker /� �� Manufacturer �a'� Model Number �� /�� CX / Size Located At� � � O�'/ra c,/L �� Serial Number 57 b�g 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 �� psid Held at �•� psid Opened at Opened at Held at Initia]Test Closed Tighti�! Closed Tight �' psid psid psid Leakedl� Leaked'�� Did not open ��l Did not open f_"] Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight�J Closed Tight❑ psid psid psid Test gauge used:Make/Model �O�^'� �� SN: Z�� Date Tested for Accuracy: � �Ff t� Remarks: The above is certified to be true at the time of testing. FirmName �,�� Firm Address 3� �✓� �' '� Certified Tester(print)�aV�C� - c�1� Certified Tester(signature) � � Firm Phone# Z�7—��l�o�� Cert.Tester No.P��'�P�� Date lQ 30 /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 far recordkeeping purposes: � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: I 3�3 l�.�t�r� e►' ��r � �� CONTACT PERSON/PHONE: ` LOCATION OF SERVICE: l '� c�-�e e5 m� 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 �Double Check Valve �Double Check-Detector ❑PressureVacuumBreaker ❑Spill-Resistant Pressure Vacuum Breaker Manufacturer �.�C�T� Model Number ��m � � Size zr r Located At �_ i.� f�5""rm�r�`-i �'C� Serial Number ��T�� Is thc assembly installed in accordance with manufacturer rccommcndations and/or 1oc21 c�1cs? 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 l� psid Held at 1��f psid Opened at Opened at Held at Initial Test Closed Tightl� Closed Tight l5� psid psid psid Leaked❑ Leaked'.-� Did not open C. 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 n psid psid psid Test gauge used:Make/Model �`'►'' �r�`�`� ` —�Z�� SN: �� Date Tested for Accuracy: Q /� �7 Remarks: The above is certified to be true at the time of testing. FirmName � �� sD Firm Address �30.�� /�V .�.j� � �1.� � ' Certified Tester(print) ��"iC� �t' Certified Tester(signature) � Firm Phone# ��T�`�� Cert.Tester No. f�� Date �l� 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 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) ��` �"1� �, ,� MAILING ADDRESS: 130� �� ' PP� \ � CONTACT PERSON/PHONE:'� � i Z�y'y b' 4 V LOCATION OF SERVICE: I ZO l�-F es 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 �Double Check Valve �IDouble Check-Detector i�PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker 0�7 rn ��_ '' Manufacturer �l`�t'� Model Number Size z Located At � " Serial Number a" Zg�� Is the assembly installed in acco dance 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 �� psid Held at 2. I psid Opened at Opened at Held at Initial Test Closed Tight� Closed Tight �} psid psid psid Leaked� Leaked' ; Did not open '�� Did not open 'J LeakedCi Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight i 1 Closed Tight'�l psid psid psid Test gauge used: Make/Model �/ri�Vb�p �'Z�f� SN: ��Dd Q Date Tested for Accuracy: q'1�� Remarks: The above is certified to be true at the time of testing. FirmName�—�U�'-l' .�� Firm Address ��J � �✓. I S � Certified Tester(print) �� 1� Certified Tester(signature) � FirmPhone# �1�� Q�7� Cert.TesterNo. tJf0��o7� Date �� o �� * 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 x 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 recardkeeping purposes: � BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: CITY OF COPPELL PWS I.D. #0570040 (Customer) MAILING ADDRESS: 13U� �`�h �e►' c�r ��( �X CONTACT PERSON/PHONE: �s�` �� Z�4—`E b� d`-fb LOCATION OF SERVICE: i Zo a► QS "�� 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 �a't`�'S Model Number � Size ��Z� Located At �1^��h Serial Number �Z� � T 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 Z-� Opened at Held at Initial Test Closed Tight❑ Closed Tight ��I psid psid psid Leaked❑ Leaked� Did not open ❑ Did not open ❑ Leakedi 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 �''''�hrAcv `'�� ZDd��C' SN: Z``�J gOC�b Date Tested for Accuracy: g�/S� f'� Remarks: The above is certified to be true at the time of testing. FirmName �Dl�-6� -L�� Firm Address /� �Qt'7 ' �✓ ' �'�l . Certified Tester(print) �!f � Certifi�d Tester(signature) � Firm Phone# Z/�—� '�1� —�(�`� Cert.Tester No. �J(��7rJ�j Date j0 30//� *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: �3D� (�.�r / �'� e, �I '�X CONTACT PERSON/PHONE: v` i Z►'f'``f'`� - � � LOCATION OF SERVICE: I Zf7 a-�C. eS 1 rr}c� 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 uced Pressure Principle ❑Reduced Pressure Principle-Detector ouble Check Valve C�Double Check-Detector ❑PressureVacuumBreaker �Spill-Resistant Pressure Vacuum Breaker ` �� i� Manufacturer �cttt� Model Number ��7 /n� � Size Located At ��r�d ConC�SS i On Serial Number �0�� Z� Is the assembly installed in accordance with manufacturer recommendations and/or local codes? `re5 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 ��3 psid Held at 2.'S psid Opened at Opened at Held at Initial Test Closed Tight�' Closed Tight �J psid psid psid Leaked�� Leakedi i 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 Ll Closed Tight❑ psid psid psid Test gauge used:Make/Model �pM��C� `�Q'Z-� I F- SN: ��Q�� Date Tested for Accuracy: `��Ffl/7 Remarks: The above is certified to be true at the time of testing. Firm Name�Q/��/ J- � Firm Address � ��J ��l � �-%/ `�-'�r Certified Tester(print) �QV►d �►��-7 Certified Tester(signature) � � � Firm Phone# �'T -"r I(o'`!Y�� Cert.Tester Na �V��O 7�Date �� 3a !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: I O CONTACT PERSON/PHONE: v► �l Z i`� -y�� -F�a`�'v LOCATION OF SERVICE: 1 Zo s�-Ec�S �«xL 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 ``iReduced Pressure Principle-Detector ❑DoubleCheckValve �!Double Check-Detector ��PressureVacuumBreaker '7Spi11-Resistant Pressure Vacuum Breaker Manufacturer (�Q-�'�'S Model Number � �C� Size 3�� Located At IY1eG� �t� �r,�ce55%on �� Serial Number �bZ�D`?j D9�S Is the assembly installed in accordance with manufacturer recommendations and/or local codes? �e 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 .�•O Opened at Held at Initial Test Closed Tight'i� Closed Tight � psid psid psid Leaked� Leaked' 1 Did not open "� Did not open `� Leaked' I Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ ClosedTight�7 psid psid psid Test gauge used:Make/Model �rv��'/'o-c.0 �a'7-� �I� SN: ZS�S(�6� Date Tested for Accuracy: 9�I�'��7 Remarks: The above is certified to be true at the time of testing. Firm Name ��e�� s�- S� Firm Address ��3 Wr`avi � ��/ �p �l�� Certified Tester(print)�v ic� � Certified Tester(signature) � � Firm Phone# �I� -`f�� Cert.Tester No.��o Date �a 3 D 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 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) Ma1L��ADD�ss: r 3n� ' C� �(l �x CONTACT PERSON/PHONE: `f— � `��`�"b LOCATION OF SERVICE: Zt3 r c.� 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 r 1 1 ` �, �r Manufacturer C�Jo�,'t"t� Model Number L.��"� �YI-3 aT Size� Located At �flL'�SS i Or1 �-� ��I ��e�� Serial Number �Z.-�5�� 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 $��psid Held at psid Opened at 2•7 Opened at Held at Initial Test Closed TightC�k Closed Tight ❑ psid psid psid Leaked�J Leaked'�� Did not open ❑ Did not open ❑ Leaked❑ Repairs/ Materials Used Held at psid Held at psid Test After Opened at Opened at Held at Repair Closed Tight❑ Closed Tight�7 psid psid psid Test gauge used:Make/Model �M �I�C� �� Z� L SN: 2-5$�O� Date Tested for Accuracy: $' 1 ? Remarks: The above is certified to be true at the time of testing. Firm Name l�0(�� I .�,L 5� Firm Address ��J �'�e1'l I P�!/ �r Certified Tester(print) �t�1� �� Certified Tester(signature) � � Firm Phone# �� '�/�P`�Q`� Cert.TesterNo. / ��C�Date �� 3Q *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