135S_DentonTapRd_75019_62902 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-30292
Test Date: 1/20/2019
Result: Passed
Reason for Test: Existing
Account Name : Schlotzskys
Address of Assembly : 135 S.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 :009QT Size :1/2 Serial No :372993
Location At:dining room 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:1/20/2019
Time:8:30 AM
Held at 8.7 psid
Closed Tight
Leaked
Held at 8.4 psid
Closed Tight
Leaked
Opened at 3 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.: 03090462
Date Tested for Accuracy: 4/15/2018
Remarks :Rebuilt RPZ ,new RV,new checks,seat and seat oring.
Firm Name : BH Backflow Licensed Tester : Bruce Hardin
Firm Address : P.O.Box 270115 BPAT License # : BP0012720
Firm Phone No : 214-502-7100 License Expiration Date : 01/08/2022
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.