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NEW_1535SBELTLINE_75019_125731 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-101310 Test Date: 11/9/2020 Result: Passed Reason for Test: New Account Name : Current Water Customer Address of Assembly : 1535 S BELTLINE : 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 :Double Check Valve Frequency :Annual What does this serve? Domestic Manufacturer :Watts ByPass : Model No :007M1QT ByPass : Size :2 ByPass : Serial No :049798 ByPass : Location At:@ METER 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:11/9/2020 Time:4:00 PM Held at 1.6 psid Closed Tight Leaked Held at 1.6 psid Closed Tight Leaked Opened at 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: Apollo Model: 40-200-TK5U Serial No.: 11100434 Date Tested for Accuracy: 11/6/2020 Remarks : Firm Name : Southwest Fire &Security,LLC Licensed Tester : Jason Holmes Firm Address : 400 Industrial Blvd,Ste#204 BPAT License # : BP0013549 Firm Phone No : 817-477-4355 License Expiration Date : 12/30/2022 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.