920SBeltlineSuite100_75019_35503 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-28263
Result: Passed
Account Name : Rozana Market
Address of Assembly : 920 S Beltline Suite 100
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 :LF009M2QT Size :1 1/4 Serial No :15512
Location At:Water Heater
What does this serve? Irrigation
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 9.2 psid
Closed Tight
Leaked
Held at 9.2 psid
Closed Tight
Leaked
Opened at 3.4 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 : Non-Potable
Make : Conbraco Model : 20-400 TKP Serial No. : 264420 Date Tested for Accuracy : 7/20/2017
The above is certified to be true at the time of testing.
Firm name : !!!!CHEAPEST/FASTEST!!!!Certified Tester : Chris Jones
Firm Address : 1846 E.Rosemeade #204 Certified Tester No. : BP0005881 Exp.Date : 06/04/2020
Firm Phone No : 214-597-1760 Test Date : 11/6/2017
*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.