196FreeportPkwy_75019_79273 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-26885
Test Date: 10/7/2019
Result: Passed
Reason for Test: Existing
Account Name : Security Frie Sytems
Address of Assembly : 196 Freeport Pkwy
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 Assembly Frequency :Annual What does this serve? FireLine
Manufacturer :Watts ByPass : Model No :757 ByPass : Size :8 ByPass : Serial No :RB0387 ByPass :
Location At:entrance vault
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 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:10/7/2019
Time:1:00 PM
Held at 3.9 psid
Closed Tight
Leaked
Held at 3.3 psid
Closed Tight
Leaked
Opened at psid
Did not open
Held at psid
Closed Tight
Leaked
Opened at psid
Image: check.gif
Did not
open
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: Potable Make: Apollo Model: 40-200-TK5U Serial No.: 03060967
Date Tested for Accuracy: 10/7/2019
Remarks :
Firm Name : Security Fire Systems Licensed Tester : Jamil Haydous
Firm Address : 196 Freeport pkwy.BPAT License # : BP0018736
Firm Phone No : (817)681-6312 License Expiration Date : 11/07/2021
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.