115NDentonTapRd_75019_54249 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-40556
Test Date: 11/13/2018
Result: Failed
Reason for Test: Existing
Account Name : Taco Bell #35411
Address of Assembly : 115 N Denton Tap 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 :Reduced Pressure Principle Frequency :Annual What does this serve? Domestic
Manufacturer :Watts Model No :009 Size :1/2 Serial No :320032
Location At:Syrup rack
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:11/13/2018
Time:10:30 AM
Held at 0 psid
Closed Tight
Leaked
Held at 0 psid
Closed Tight
Leaked
Opened at 0 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: TG5 Serial No.: 04100965
Date Tested for Accuracy: 3/28/2018
Remarks :Check #1 leaked -Device failed -will return to repair.
Firm Name : DNK Backflow Services Licensed Tester : Donnie Grant
Firm Address : 1012 Blaylock Cir S BPAT License # : BP0008813
Firm Phone No : 972-253-2154 License Expiration Date : 02/03/2020
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.