1080ESandyLake_75019_33047 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-22047
Result: Passed
Account Name : Mario's Pizza
Address of Assembly : 1080 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 :Reduced Pressure Principle Frequency :Annual
Manufacturer :Watts Model No :009M3QT Size :3/4 Serial No :91672
Location At:above the mop sink
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 7.7 psid
Closed Tight
Leaked
Held at 7.3 psid
Closed Tight
Leaked
Opened at 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 : Conbraco Model : 40-200-TK5 Serial No. : 01022266 Date Tested for Accuracy : 11/23/2016
The above is certified to be true at the time of testing.
Firm name : .007 Next Day Backflow Testing Certified Tester : Israel Lambert
Firm Address : 1417 Abilene Ct Certified Tester No. : BP0016675 Exp.Date : 07/01/2018
Firm Phone No : 214-218-6415 Test Date : 10/5/2017
*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.