585SRoyalLnSte200_75019_47802 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-22085
Test Date: 7/26/2018
Result: Passed
Reason for Test: Existing
Account Name : Dexas International
Address of Assembly : 585 S Royal Ln Ste 200
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? FireLine
Manufacturer :Ames Model No :4000B Size :2 Serial No :06008
Location At:@ ceiling by offices
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:7/26/2018
Time:12:12 PM
Held at 8 psid
Closed Tight
Leaked
Held at 8 psid
Closed Tight
Leaked
Opened at 2.4 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.: 06110075
Date Tested for Accuracy: 8/25/2017
Remarks :
Firm Name : Action Fire Pros Licensed Tester : Jason Huston
Firm Address : 3709 S I-35 E BPAT License # : BP0010651
Firm Phone No : 800-550-2287 License Expiration Date : 07/03/2019
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.