1111FreeportPkwy__75019_79044 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-22623
Test Date: 10/2/2019
Result: Passed
Reason for Test: Existing
Account Name : Avaya
Address of Assembly : 1111 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 Frequency :Annual What does this serve? Domestic
Manufacturer :Wilkins ByPass : Model No :350 ByPass : Size :3 ByPass : Serial No :I57267 ByPass :
Location At:Fire riser room
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:10/2/2019
Time:3:00 PM
Held at 2.4 psid
Closed Tight
Leaked
Held at 1.4 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: Wilkins Model: TG5 Serial No.: 06110082
Date Tested for Accuracy: 8/1/2019
Remarks :
Firm Name : Total Fire and Safety,Inc.Licensed Tester : MICHAEL KISINGER
Firm Address : 7909 Carr St.BPAT License # : BP0016858
Firm Phone No : 214-381-6116 License Expiration Date : 09/29/2021
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.