1111ExecutiveDrive_75019_34876 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-28064
Result: Passed
Account Name : San Mar Corp
Address of Assembly : 1111 Executive Drive
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 :Watts Model No :007M1 Size :2" Serial No :21960
Location At:Front of building at street
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 1.8 psid
Closed Tight
Leaked
Held at 1.6 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 : Wilkins Model : TG-5 Serial No. : 07090488 Date Tested for Accuracy : 6/6/2017
The above is certified to be true at the time of testing.
Firm name : Action Fire Pros Certified Tester : Kenneth Cooper
Firm Address : 3709 I35 E Certified Tester No. : BP0006157 Exp.Date : 05/13/2018
Firm Phone No : 800-550-2287 Test Date : 10/19/2017
*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.