585SRoyalLnSte200_75019_28299 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
City:Coppell
PWS I.D.:0570040
Address:816 S.Coppell Road
Coppell,Texas 75019
Phone:972-462-5150
Contact Person:Jerry Davis
Catalog No: TXTCOP-22085
Result: Passed
Account Name : Dexas International
Address of Assembly : 585 S Royal Ln Ste 200
Address Type : Commercial
Inspection
The backflow prevention assembly detailed below has been tested as required by TCEQ regulations and is certified to be
operating within acceptable parameters.
Type of Assembly :Reduced Pressure Principle Frequency :Annual
Manufacturer :Ames Model No :4000B Size :2 Serial No :06008
Location At:@ ceiling by offices
What does this serve? FireLine
Is the assembly installed in accordance with manufacturer recommendations and/or local codes?Yes
Reduced Pressure Principle Assembly Pressure Vacuum Breaker
Double Check Valve Assembly
1st check 2nd check Relief Valve Air Inlet Check Valve
Held at 9.3 psid
Closed Tight
Leaked
Held at 9.1 psid
Closed Tight
Leaked
Opened at 4 psid
Did not open
Opened at psid
Did not open
Held at psid
Leaked
Repairs and Materials Used
Test Results after Repair
1st check 2nd check Relief Valve Air Inlet Check Valve
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid Opened at psid Held at psid
Remarks :
Test gauge used : Potable
Make : Wilkins Model : TG_5 Serial No. : 07090476 Date Tested for Accuracy : 9/23/2016
The above is certified to be true at the time of testing.
Firm name : Action Fire Pros Certified Tester : Allen Stevens
Firm Address : 3709 S I-35 E Certified Tester No. : BP0009860 Exp.Date : 07/31/2018
Firm Phone No : 972-923-0711 Test Date : 7/17/2017
*Test Records must be kept for at least three years.
**Use only manufacturer's replacement parts.
The following form must be completed for each assembly tested.