631SRoyalLn_75019_38162 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-22187
Test Date: 1/12/2018
Result: Passed
Reason for Test: Existing
Account Name : Mitsubishi Electric Cooling and Heating
Address of Assembly : 631 S Royal Ln
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 :007M1 Size :2 Serial No :A11039
Location At:meter
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:1/12/2018
Time:1:12 PM
Held at 2.6 psid
Closed Tight
Leaked
Held at 2 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: wilkins Model: tg-5 Serial No.: 04111956
Date Tested for Accuracy: 4/20/2017
Remarks :
Firm Name : koetter fire protection Licensed Tester : gary glover
Firm Address : 10351 olympic dr BPAT License # : BP0011572
Firm Phone No : (214)358-3593 License Expiration Date : 09/12/2020
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.