401SouthwesternBlvd_75019_37941 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-21256
Test Date: 1/11/2018
Result: Passed
Reason for Test: Existing
Account Name : Current water Customer
Address of Assembly : 401 Southwestern Blvd
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 What does this serve? Domestic
Manufacturer :Watts Model No :LF007M1QT Size :2 Serial No :024442
Location At:front pkwy at meter bldg H
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:1/11/2018
Time:9:00 AM
Held at 2.6 psid
Closed Tight
Leaked
Held at 2.4 psid
Closed Tight
Leaked
Opened at 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: Apollo Model: 40-200-TK5U Serial No.: 01111188
Date Tested for Accuracy: 2/21/2017
Remarks :
Firm Name : Action Fire Pros.Licensed Tester : Wesley Higgs
Firm Address : 3709 S IH 35 E BPAT License # : BP0014258
Firm Phone No : 214-549-7793 License Expiration Date : 11/30/2020
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.