NEW_140W_SandyLakeRd_Bldg_B_75019_49729 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-38457
Test Date: 8/20/2018
Result: Passed
Reason for Test: New
Account Name : Sunny Street Cafe
Address of Assembly : 140 W.Sandy Lake Rd.Bldg.B
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? Carbonator
Manufacturer :Watts Model No :SS009M3QT Size :1/2 Serial No :18676
Location At:Carbonator
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:8/20/2018
Time:10:00 AM
Held at 8.8 psid
Closed Tight
Leaked
Held at 8.6 psid
Closed Tight
Leaked
Opened at 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: LONGHORN Model: 845-5-0007 Serial No.: 01050942
Date Tested for Accuracy: 1/3/2018
Remarks :
Firm Name : RD MOORMAN,INC Licensed Tester : MOSES KEMP
Firm Address : 417 WYNDEMERE BLVD BPAT License # : BP0014971
Firm Phone No : 972-722-2408 License Expiration Date : 11/30/2018
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.