505HoustonSt__75019_37286 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Name of PWS:Coppell
PWS I.D.:0570040
Address:816 S.Coppell Road
Coppell,Texas 75019
Phone:972-462-5150
Contact Person:Jerry Davis
Catalog No: TXTCOP-22842
Result: Passed
Reason for Test: Existing
Account Name : Twisted Root
Address of Assembly : 505 Houston St.
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 :0 Frequency :Annual What does this serve? Domestic
Manufacturer :Watts Model No :LF009M3QT Size :3/4 Serial No :108283
Location At:Chicken shake ice machine
Is the assembly installed in accordance with manufacturer recommendations and/or local codes?Yes
Is the assembly installed on a non-potable water supply (auxiliary)?No
Reduced Pressure Principle Assembly Pressure Vacuum Breaker
Double Check Valve Assembly
1st check 2nd check Relief Valve Air Inlet Check Valve
Initial Test
Date:12/20/2017
Time:1:00 PM
Held at 8.1 psid
Closed Tight
Leaked
Held at 7.7 psid
Closed Tight
Leaked
Opened at 4.4 psid
Did not open
Opened at psid
Did it fully open
Yes No
Held at psid
Leaked
Repairs and Materials
Used **
Test After Repair
Date:
Time:
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid Opened at psid Held at psid
***2nd check:numeric reading required for DCVA only
Test gauge used: Potable Make: Midwest Model: 845-5 Serial No.: 02171599
Date Tested for Accuracy: 2/15/2017
Remarks :
Firm Name : All Test Service Solutions Licensed Tester : Kyler Robertson
Firm Address : 600 Henrietta Creek Rd.#100BPAT License # : BP0016972
Firm Phone No : (817)379-0856 License Expiration Date : 12/10/2018
The above is certified to be true at the time of testing.
* Test Records must be kept for at least three years.[30 TAC §290.46(B)]
** Use only manufacturer's replacement parts.