217Wrangler_75019_92200 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-34139
Test Date: 2/10/2020
Result: Passed
Reason for Test: Existing
Account Name : Current Water Customer
Address of Assembly : 217 Wrangler : 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 :009 ByPass : Size :1/2 ByPass : Serial No :334628 ByPass :
Location At:old break room -217 Wrangler
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:2/10/2020
Time:12:00 PM
Held at 7.6 psid
Closed Tight
Leaked
Held at 7.6 psid
Closed Tight
Leaked
Opened at 2
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: Mid-West Model: 845-5 Serial No.: 02190795
Date Tested for Accuracy: 1/23/2020
Remarks :
Firm Name : Ideal Fire &Security,LLC Licensed Tester : Matt Henderson
Firm Address : 6913 Camp Bowie Blvd.Suite 181 BPAT License # : BP0018839
Firm Phone No : 817-222-1283 License Expiration Date : 02/06/2022
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.