944WSandyLakeRd_75019_78053 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-22048
Test Date: 9/18/2019
Result: Passed
Reason for Test: Existing
Account Name : Kimberly-Clark Corporation
Address of Assembly : 944 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 ByPass : Model No :LF009QT ByPass : Size :1/2 ByPass : Serial No :228869 ByPass :
Location At:Vending breakroom ice rm 109 &110
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)?Yes
Reduced Pressure Principle Assembly Type II
Assembly
Pressure Vacuum Breaker
Spilled-Resistant Vacuum BreakerDoubleCheckValveAssembly
1st check 2nd check Relief Valve Bypass Check Air Inlet Check Valve
Initial Test
Date:9/18/2019
Time:9:00 AM
Held at 8 psid
Closed Tight
Leaked
Held at 7.8 psid
Closed Tight
Leaked
Opened at 4
psid
Did not open
Held at psid
Closed Tight
Leaked
Opened at psid
Did it fully open
Yes No
Held at psid
Leaked
Repairs andMaterialsUsed **
Test After Repair
Date:
Time:
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid Held at psid
Closed Tight
Leaked
Opened at psid Held at psid
***2nd check:numeric reading required for DCVA only
Test gauge used: Non-Potable Make: Conbraco Model: 40-200-TKP Serial No.: 264420
Date Tested for Accuracy: 7/9/2019
Remarks :
Firm Name : !!!!Cheapest Fastest !!!!Licensed Tester : Chris Jones
Firm Address : 1846 E.Rosemeade #204 BPAT License # : BP0005881
Firm Phone No : 903-408-0848 License Expiration Date : 06/04/2020
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.