330SRoyal_75019_59820 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-22080
Test Date: 11/29/2018
Result: Passed
Reason for Test: Existing
Account Name : RAB Lighting
Address of Assembly : 330 S Royal
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 :Double Check Valve Frequency :Annual What does this serve? FireLine
Manufacturer :Wilkins Model No :350 Size :10 Serial No :N43009
Location At:west side of bldg
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:11/29/2018
Time:7:00 AM
Held at 2.8 psid
Closed Tight
Leaked
Held at 3 psid
Closed Tight
Leaked
Opened at 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: APOLLO Model: 40-200 TK5U Serial No.: 01142592
Date Tested for Accuracy: 2/21/2018
Remarks :
Firm Name : IMPACT FIRE SERVICES Licensed Tester : William Edwards
Firm Address : 921 W.Mayfield #136 BPAT License # : BP0015851
Firm Phone No : 817-217-4014 License Expiration Date : 05/22/2020
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.