1075S_BeltLineRd__75019_45310 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-22385
Test Date: 6/12/2018
Result: Passed
Reason for Test: Existing
Account Name : Current Water Customer
Address of Assembly : 1075 S.Belt Line Rd.
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 :Pressure Vacuum Breaker Frequency :Annual What does this serve? Domestic
Manufacturer :Watts Model No :LF008PCQT Size :3/4 Serial No :00238
Location At:Production Mezzanine/#300
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:6/12/2018
Time:8:45 AM
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid
Did not open
Opened at 2 psid
Did it fully open
Yes No
Held at 3.4 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: Mid-West Model: 845-5-0011 Serial No.: 12071470
Date Tested for Accuracy: 1/5/2018
Remarks :
Firm Name : TDIndustries Licensed Tester : Donald Morgan
Firm Address : 13850 Diplomat BPAT License # : BP0003868
Firm Phone No : 972-888-9500 License Expiration Date : 04/01/2020
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.