508WranglerDr#100_75019_88471 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-23042
Test Date: 1/16/2020
Result: Passed
Reason for Test: Existing
Account Name : ZS Parma Inc
Address of Assembly : 508 Wrangler Dr #100 : 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 :1 ByPass : Serial No :018340 ByPass :
Location At:warehouse at storage tanks
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:1/16/2020
Time:1:05 PM
Held at 9.1 psid
Closed Tight
Leaked
Held at 9 psid
Closed Tight
Leaked
Opened at 4
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 and
Materials Used **
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.: 05141063
Date Tested for Accuracy: 7/11/2019
Remarks :
Firm Name : Allied Flow Specialists,Inc.Licensed Tester : Christopher Coffman
Firm Address : PO Box 1150 BPAT License # : BP0016261
Firm Phone No : 972-723-5535 License Expiration Date : 11/25/2020
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.