NEW_944WSandyLakeRd_75019_80338 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: 10/14/2019
Result: Passed
Reason for Test: Replacement
Previous Serial No.: 3870697XLD
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 :Double Check Valve Frequency :Annual What does this serve? FireLine
Manufacturer :Wilkins ByPass : Model No :950XL2 ByPass : Size :3/4"ByPass : Serial No :H029888 ByPass :
Location At:NW 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:10/14/2019
Time:10:00 AM
Held at 1.4 psid
Closed Tight
Leaked
Held at 1.6 psid
Closed Tight
Leaked
Opened at psid
Did not open
Held at psid
Closed Tight
Leaked
Opened at psid
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-TK3U Serial No.: 12060282
Date Tested for Accuracy: 4/5/2019
Remarks :
Firm Name : Firetrol Protection Systems Licensed Tester : Bill Speake
Firm Address : 10320 Markison Rd BPAT License # : BP0005544
Firm Phone No : 214-343-9200 License Expiration Date : 06/19/2020
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.