NEW_DEVICE_503Evergreen_75019_29713 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-22322
Result: Passed
Account Name : Current Water Customer
Address of Assembly : 503 Evergreen
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 :Wilkins Model No :375XL Size :1 Serial No :B128751
Location At:Health Containment
What does this serve? Domestic
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 10.1 psid
Closed Tight
Leaked
Held at 9.8 psid
Closed Tight
Leaked
Opened at 4.6 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 : Midwest Model : 805 Serial No. : 02150709 Date Tested for Accuracy : 4/6/2017
The above is certified to be true at the time of testing.
Firm name : Vintage Drain Cleaning and PlumbingCertified Tester : Ellis High
Firm Address : 209 West 2nd Street,Suite 392 Certified Tester No. : BP0016467 Exp.Date : 03/27/2018
Firm Phone No : 817-655-0776 Test Date : 8/2/2017
*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.