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BAKCFLOW CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ,_-"" CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT I NSTALLATION-REPAI RS-TESTING-CERTIFICATION it • 'Stro4ClaN'9sa BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3589) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650 SERVICE ADDRESS 22622 Marianist Way.,Cuperiino/X-Vos&Foothill Blvd MAILING ADDRESS The Marianist Center CONTACT SteVC 22622 Marianist Way TEL# 253-6979 Cupertino, CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER FebDo 765 PVB 2" 80610 INTERNAL TAG LOCATION OF DEVICE irrigation EXTERNAL Cl IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[:I PASSWFAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECKVALVE CHECK VALVE PRESSURE/RELIEF N0,1 N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT ❑ CLOSED TIGHT Cl //,,OPENED AT_LES. OPENED AT7 '�LBS CLOSED TIGHT INITIAL #lbs. #lbs. #LBS #LBS. 7- Z TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND ` MATERIALS USED FINAL CLOSED TIGHT Cl CLOSED TIGHT ❑ CLOSED TIGHT❑ TESTOPENED AT_LBS OPENED AT_LBS #LBS #LBS #ls5 THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BV CERTIFIED TESTER NO.Z� DATE 3-17-03 • REPAIRED BY DATE MO. DAY YR. FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS �sA1". CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2800 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2850 SERVICE ADDRESS 22622 Marianist Way.,Cupertino/X-Vos&Foothill Blvd MAILING ADDRESS The Marianist Center CONTACT Steve 22622 Marianist Way TEL# 253-6979 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009M1 RP 2" 91593 INTERNAL ❑ TAG LOCATION OF DEVICE next to fence by dining ball irrigation EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASA FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF NO.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSEDTIGHT • LBS.CLOSEDTIGHTO_ OPENED ATZOPENEDAT_LBS CLOSED TIGHT ❑ INITIAL #Ibs.—fpL)r� #Ibs. ALBS #LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED v.. FINAL CLOSED TIGHT Cl CLOSED TIGHT ❑ CLOSED TIGHT❑ ' TEST III LBS #LBS OPENED AT_LBS OPEN ED AT_LBS t LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY �ZOG CERTIFIED TESTER NO, DATE 3-17-03 •. MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS �_ •��//��... CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION BACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650 SERVICE ADDRESS 22622 Marlanist Wy.,Cupertino MAILING ADDRESS ThC MarlanlSt Center CONTACT .SteVC 22622 Marianist Wy TEL# 253-6279 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975)CLSE RP 2° 1382169 INTERNAL ❑ TAG LOCATION OF DEVICE mtr#23129255 EXTERNAL v� IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASS FAIL, • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENEDAT3• V LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL #IDs. #16s. #LBS #LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS SGS�/�Cc'GS AND MATERIALS USED FINAL CLOSED TIGHT❑ CLOSED TIGHT El CLOSED TIGHT❑ TEST #LBS #LBS OPENED AT_LBS OPENED AT_LBS I LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY�i y�—P CERTIFIED TESTER NO. DATE 3-17-03 �. REPAIRED BY ROTE MO. DAY YR. FINAL TEST BY CERTIFIED TESTER NO. DATE .- MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS INSTALLATION-REPAIRS-TESTING-CERTIFICATION SMnrr4ap?w# BACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650 SERVICE ADDRESS 22622 Marianist Wy.,Cupertino MAILING ADDRESS The Manamst Center CONTACT Steve 22622 Marianist Wy TEL# 253-6279 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wim W03920 RP 2° x(003920 INTERNAL ❑ TAG LOCATION OF DEVICE mtr#23129255 EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASS,q,I FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF N0.1 N0.2VALVE AIR INLET CHECK VALVE � 7 - CLOS pTIGHT CLOSED TIOHT� OPENED ATJ•oLBS. OPENED AT_LBS CLOSEDTIGHT ❑ INITIAL #lbs. z #lbs. #LBS #LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED r� FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ ,CLOSED TIGHT❑ TEST #LBS #LBS OPENED AT_LBS OPENED AT_LBS IBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO, z 6 S DATE 3-17-03 • "MO. DAY YR REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. b• DATE MO. DAY YR.