NEW_185W_ParkwayBlvd__75019_44585 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-36143
Test Date: 5/29/2018
Result: Passed
Reason for Test: New
Account Name : Coppell High School
Address of Assembly : 185 W.Parkway 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 :LF007M3QT Size :3/4 Serial No :082843
Location At:Back room Field House 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
Spilled-Resistant Vacuum BreakerDoubleCheckValveAssembly
1st check 2nd check Relief Valve Air Inlet Check Valve
Initial Test
Date:5/29/2018
Time:10:15 AM
Held at 0 psid
Closed Tight
Leaked
Held at 0 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 **Cleaned debris out of assembly
Test After Repair
Date:5/29/2018
Time:10:30 AM
Held at 1.8 psid
Closed Tight
Leaked
Held at 1.6 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: MG Model: 844-5 Serial No.: 11010409
Date Tested for Accuracy: 1/12/2018
Remarks :Debris in Check Valves
Firm Name : Kalan Backflow Service Licensed Tester : Ken Cartwright
Firm Address : 2022 Kendolph Drive BPAT License # : BP0002430
Firm Phone No : 940-367-4819 License Expiration Date : 02/12/2020
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.