160WSandyLakeBlvd_75019_78531 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-38250
Test Date: 9/20/2019
Result: Passed
Reason for Test: Existing
Account Name : Woodside Shopping Center
Address of Assembly : 160 W Sandy Lake Blvd
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 :LF909M1 ByPass : Size :2 ByPass : Serial No :014848 ByPass :
Location At:mech room back of store bldg A
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:9/20/2019
Time:10:20 AM
Held at 10.8 psid
Closed Tight
Leaked
Held at 11 psid
Closed Tight
Leaked
Opened at 2
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: Potable Make: Conbraco Model: 40-200-TKP Serial No.: 219562
Date Tested for Accuracy: 1/4/2019
Remarks :
Firm Name : Professional Choice Fire and Security Systems Licensed Tester : Dwanald Walker
Firm Address : 1815 N.Hampton Road BPAT License # : BP0011708
Firm Phone No : 972-298-2303 License Expiration Date : 10/30/2020
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.