100W_SandyLakeRd__75019_65809 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-39641
Test Date: 3/6/2019
Result: Passed
Reason for Test: Existing
Account Name : 7 -Eleven
Address of Assembly : 100 W.Sandy Lake 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 :LF009M3QT Size :3/4 Serial No :197932
Location At:Above hand sink
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:3/6/2019
Time:10:32 AM
Held at 10 psid
Closed Tight
Leaked
Held at 9.8 psid
Closed Tight
Leaked
Opened at 2.2 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 :
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.