1301Wrangler_75019_48117 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-37779
Test Date: 8/2/2018
Result: Passed
Reason for Test: Existing
Account Name : Current Water Customer
Address of Assembly : 1301 Wrangler
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 :LF009M2 Size :1 1/2 Serial No :041849
Location At:by water filter in kitchen
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:8/2/2018
Time:1:00 PM
Held at 9.2 psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at 2.8 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: Mid-West Model: 845-5-0029 Serial No.: 02152044
Date Tested for Accuracy: 7/3/2018
Remarks :
Firm Name : Backflow Preventer Testing &Repair Service Licensed Tester : Dax Gonzalez
Firm Address : 2616 Handley Dr BPAT License # : BP0015237
Firm Phone No : 817-705-0237 License Expiration Date : 04/30/2019
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.