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Home My WebLink AboutPLIRR2025-002299 (3)Texas Commission on Environmental Quality BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT The ronowii: to= must he colIM,kied for mwh Amcntbh tested. A sig! r � ., ordk, origmal mu.4 besubautte4 to the mNic water xu,�plicr fo rec in- f,w cases: NAME OF PWS: Grp PWS ID#: PWS MAILl`NG ADDRESS: Br,,)ok PPS CONTACT PERSON* Bagm-M&porclinotor ADDRESS OF SERVICE: The bat ow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be oiwariw., within acceptable I.arameters. TYPE OF BACKFWW PREVENTION ASSEMBLY (BPA Reduced Pressure Principle (RPBA) 0 Reduced Pressure Principle -Detector (RPBA-D) Type 1110 ... . ........ Double Check Valve (DCVA) 0 Double Check -Detector VA-) Type 11,0 Pressure Vacuum Breaker (PVB) E] Spill -Resistant Pressure Vacuum Breaker (SVB) _7 - Manufacturer. Main: Bypass,1 L.Main- Bypass - Model Number: Main: Bypass,: BPA Location: Serial Number: Bypa&s BPA Serves: PERMIT NUMBER: Replacement 0: Old Model/Serial 4 Reason for test: New Existing [3 �CSIs the assembly installed in accordance with manufacturer recommendations and/or loc a I c o de s 0No, Is the assembly instafled on a non -potable water supply (auxiliary)? 0 Yes No Type B TEST RESULT Reduced Pressure Principle Assembly (RPB Amsse PV`B & SVJ3 111 jHeldat " :psid ed T' Opened at �� psid I Did not open 1b . I ■ D141 it fully open 'yer; 1cf, tNo 1101� Repairs and iMain-.' Materials Used" !Bypass: 'Held at Held at ITest, After psid � Held at ____j psid Opened at ��,! k psid' Opened at psid 14C a ipsid iCloscd psi Ralair, Close Tight O'i Closed Tight 0 Tight 0 Date: =p9l, 'd Time: 2110 check: numeric readin ret aired for DCVA onk Differential pressure gauge used: Potable. Nun -Potable: Q M MidwesV845-5 Date tested for accuracv!ake/Mcdel: SX Company Name: Licensed Tester Name Chaz Richie Chaz Riche Company Address: 317 Trice at, Licensed Tester Name (Signature): "I Maypearl Tx 76064 B- Company Phone BPAT Lice nse # pod� 214-519-4410 License Exl4ation Date: w 11/18/2025 The above is certified to be true at the time of testing - TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS (30 TAC 4290-46(B)) ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS TCEQ-20700 (Revision 04-04-2019) Page I of I Texas Commission on Environmental Quality BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT The ronowii: to= must he colIM,kied for mwh Amcntbh tested. A sig! r � ., ordk, origmal mu.4 besubautte4 to the mNic water xu,�plicr fo rec in- f,w cases: NAME OF PWS: Grp PWS ID#: PWS MAILl`NG ADDRESS: Br,,)ok PPS CONTACT PERSON* Bagm-M&porclinotor ADDRESS OF SERVICE: The bat ow prevention assembly detailed below has been tested and maintained as required by commission regulations and is certified to be oiwariw., within acceptable I.arameters. TYPE OF BACKFWW PREVENTION ASSEMBLY (BPA Reduced Pressure Principle (RPBA) 0 Reduced Pressure Principle -Detector (RPBA-D) Type 1110 ... . ........ Double Check Valve (DCVA) 0 Double Check -Detector VA-) Type 11,0 Pressure Vacuum Breaker (PVB) E] Spill -Resistant Pressure Vacuum Breaker (SVB) _7 - Manufacturer. Main: Bypass,1 L.Main- Bypass - Model Number: Main: Bypass,: BPA Location: Serial Number: Bypa&s BPA Serves: PERMIT NUMBER: Replacement 0: Old Model/Serial 4 Reason for test: New Existing [3 �CSIs the assembly installed in accordance with manufacturer recommendations and/or loc a I c o de s 0No, Is the assembly instafled on a non -potable water supply (auxiliary)? 0 Yes No Type B TEST RESULT Reduced Pressure Principle Assembly (RPB Amsse PV`B & SVJ3 111 jHeldat " :psid ed T' Opened at �� psid I Did not open 1b . I ■ D141 it fully open 'yer; 1cf, tNo 1101� Repairs and iMain-.' Materials Used" !Bypass: 'Held at Held at ITest, After psid � Held at ____j psid Opened at ��,! k psid' Opened at psid 14C a ipsid iCloscd psi Ralair, Close Tight O'i Closed Tight 0 Tight 0 Date: =p9l, 'd Time: 2110 check: numeric readin ret aired for DCVA onk Differential pressure gauge used: Potable. Nun -Potable: Q M MidwesV845-5 Date tested for accuracv!ake/Mcdel: SX Company Name: Licensed Tester Name Chaz Richie Chaz Riche Company Address: 317 Trice at, Licensed Tester Name (Signature): "I Maypearl Tx 76064 B- Company Phone BPAT Lice nse # pod� 214-519-4410 License Exl4ation Date: w 11/18/2025 The above is certified to be true at the time of testing - TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS (30 TAC 4290-46(B)) ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS TCEQ-20700 (Revision 04-04-2019) Page I of I