1001ESandyLake_75019_30585 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-22043
Result: Passed
Account Name : Universal Academy
Address of Assembly : 1001 E Sandy Lake
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 :Double Check Valve Frequency :Annual
Manufacturer :Ames Model No :colt300 Size :4 Serial No :FI0370
Location At:riser room A
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 2.1 psid
Closed Tight
Leaked
Held at 1.9 psid
Closed Tight
Leaked
Opened at 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 : Apollo Model : 40-200TK5U Serial No. : 07142005 Date Tested for Accuracy : 11/17/2016
The above is certified to be true at the time of testing.
Firm name : AFPG,Inc Certified Tester : Charis Curbo
Firm Address : 10575 Vista Park Certified Tester No. : BP0016252 Exp.Date : 12/02/2017
Firm Phone No : 469-291-8113 Test Date : 8/30/2017
*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.