230NDentonTapRd#115_75019_32642 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-22023
Result: Passed
Account Name : Coppell Modern Dentistry
Address of Assembly : 230 N Denton Tap Rd #115
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 :Watts Model No :009 Size :1/2 Serial No :357226
Location At:equipment room
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 7 psid
Closed Tight
Leaked
Held at 6.8 psid
Closed Tight
Leaked
Opened at 2.2 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 : Mid-West Model : 845-5 Serial No. : 08160372 Date Tested for Accuracy : 9/5/2017
The above is certified to be true at the time of testing.
Firm name : A.C.E.Companies Certified Tester : Daniel Klein
Firm Address : 150 E Highway 67,Ste 210 Certified Tester No. : BP0014132 Exp.Date : 06/08/2019
Firm Phone No : 469-899-6050 Test Date : 9/22/2017
*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.