508WranglerDr#100_75019_137429 BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
Name of PWS:Coppell
PWS I.D.:TX0570040
Address:816 S.Coppell Road
Coppell,Texas 75019
Phone:972-462-5150
Contact Person:Jerry Davis
Catalog No: TXTCOP-23042
Test Date: 1/28/2021
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 :009M3QT ByPass : Size :3/4 ByPass : Serial No :379908 ByPass :
Location At:Production area on wall
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:1/28/2021
Time:12:02 PM
Held at 0 psid
Closed Tight
Leaked
Held at 0 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 **Installed a total rebuild kit.
Test After Repair
Date:1/28/2021
Time:12:15 PM
Held at 9.6 psid
Closed Tight
Leaked
Held at 9.5
psid
Closed Tight
Leaked
Opened at 3.6
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: 7/11/2020
Remarks :Installed a total rebuild kit.
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 : 11/25/2023
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.