705NDentonTapRd_75019_113332 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:
Catalog No: TXTCOP-22059
Test Date: 8/5/2020
Result: Failed
Reason for Test: Existing
Account Name : Rosa's Cafe #33
Address of Assembly : 705 N Denton Tap 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 :Reduced Pressure Principle Frequency :Annual What does this serve? Domestic
Manufacturer :Apollo ByPass : Model No :40204T2S ByPass : Size :3/4 ByPass : Serial No :ZX028 ByPass :
Location At:mech room
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:8/5/2020
Time:8:45 AM
Held at 7.3 psid
Closed Tight
Leaked
Held at 7.1
psid
Closed Tight
Leaked
Opened at 0
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: Midwest Model: 845-5 Serial No.: 02171602
Date Tested for Accuracy: 6/16/2020
Remarks :needs trk
Firm Name : All Test Service Solutions Licensed Tester : Kyle Mihalovich
Firm Address : 600 Henrietta Creek Rd.#100 BPAT License # : BP0017367
Firm Phone No : 817-379-0856 License Expiration Date : 06/22/2022
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.