950ESANDYLAKE_75019_110387 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-89480
Test Date: 7/20/2020
Result: Passed
Reason for Test: Existing
Account Name : KROGER 848
Address of Assembly : 950 E SANDY LAKE : 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 :Spill-Resistant Pressure Vacuum Breaker Frequency :Annual What does this serve? Domestic
Manufacturer :Watts ByPass : Model No :008PCQT ByPass : Size :1/2 ByPass : Serial No :74704 ByPass :
Location At:MOP SINK FRONT SOAP DISP
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:7/20/2020
Time:12:15 PM
Held at psid
Closed Tight
Leaked
Held at psid
Closed Tight
Leaked
Opened at psid
Did not open
Held at psid
Closed Tight
Leaked
Opened at 2
psid
Did not open
Did it fully open
Yes No
Held at 5.2 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: Wilkins Model: TG-5 Serial No.: 05141002
Date Tested for Accuracy: 1/8/2020
Remarks :
Firm Name : Kroger Fac.-Eng.Licensed Tester : Richard Mitchell
Firm Address : 751 freeport pkwy BPAT License # : BP0014816
Firm Phone No : 682-308-3777 License Expiration Date : 09/27/2021
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.