NEW_143S_DentonTapRd_#190_75019_39525 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-30841
Test Date: 2/9/2018
Result: Passed
Reason for Test: Replacement
Previous Serial No.: 125103
Account Name : Smashburger
Address of Assembly : 143 S.Denton Tap Rd.#190
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 What does this serve? Domestic
Manufacturer :Watts Model No :LF009QT Size :1/2" Serial No :146740
Location At:under sink by dishwasher
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
Spilled-Resistant Vacuum BreakerDoubleCheckValveAssembly
1st check 2nd check Relief Valve Air Inlet Check Valve
Initial Test
Date:2/9/2018
Time:11:45 AM
Held at 9.4 psid
Closed Tight
Leaked
Held at 9 psid
Closed Tight
Leaked
Opened at 2.6 psid
Did not open
Opened at psid
Did it fully open
Yes No
Held at psid
Leaked
Repairs and MaterialsUsed**
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: Longhorn Model: 845-5 Serial No.: 08040583
Date Tested for Accuracy: 10/9/2017
Remarks :
Firm Name : A &A Active Backflow Licensed Tester : Christopher Gafford
Firm Address : 1611 N IH 35E Ste 410 BPAT License # : BP0013306
Firm Phone No : 972-242-2229 License Expiration Date : 09/13/2019
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.