1030Independence_75019_32708 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-26681
Result: Passed
Account Name : Current Water Customer
Address of Assembly : 1030 Independence
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 :2000B Size :1 Serial No :16129
Location At:1030 Independence garage
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 1.8 psid
Closed Tight
Leaked
Held at 1.4 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 : MidWest Model : 845-5 Serial No. : 04142777 Date Tested for Accuracy : 3/29/2017
The above is certified to be true at the time of testing.
Firm name : Double D Fire Inc.Certified Tester : Stephen Jumper
Firm Address : PO Box 2695 Certified Tester No. : BP0016133 Exp.Date : 09/11/2020
Firm Phone No : 972-564-0564 Test Date : 9/21/2017
*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.