1075S_BeltLineRd__75019_45311 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 :008PCQT Size :1 Serial No :561668
Location At:Above wash bays/#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:9:00 AM
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid
Did not open
Opened at 1.2 psid
Did it fully open
Yes No
Held at 1.6 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.