160W_SandyLakeRd__75019_66193 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-43282
Test Date: 3/21/2019
Result: Passed
Reason for Test: New
Account Name : JC's Burgers
Address of Assembly : 160 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 :Double Check Valve Frequency :Annual What does this serve? Domestic
Manufacturer :Watts Model No :LF007QT Size :1/2 Serial No :44662
Location At:Next to ice maker
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:3/21/2019
Time:10:05 AM
Held at 2.1 psid
Closed Tight
Leaked
Held at 2 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: WILKINS/ZURN Model: TG5 Serial No.: 03181401
Date Tested for Accuracy: 3/29/2018
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 : 11/30/2021
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.