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HomeMy WebLinkAboutBackflow Pevention r' ,, CROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS "4e BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS � INSTALLATION-REPAIRS-TESTING-CERTIFICATION %ACKFLOW PREVENTION SPECIALISTS, INC, FLOW(3 800)464- 569)_ _ LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA ( (408)269.2600 � —� 1',j - 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1358 FAX(408)269-2650 >l 3608 FERNWOOD ST.,SAN MATEO CA 94403 kb Z - 2005 SERVICE ADDRESS 20450 Stevens Creek Blvd,Cu rtino/X-DeAnza Blvd. MAILING ADDRESS Prometheus CONTACT Bob 20400 Stevens Creek Blvd.,9245 TEL# 408410-6517 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC 2" R9877 INTERNAL ® TAG LOCATION OF DEVICE Roof Cooling Tower/Heat Exchanger Makeup Water EXTERNAL ❑ come OG oN Cool'�y PawW S/+e✓// 6c p 'v 'ell pG✓i c.� �.Y.r.'�� IF DEVICE IS ANlfW LLATION PLEASE CHECK THIS BOX PASS® FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF AIR INLET CHECK VALVE NOA NO.2 VALVE CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT_LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL #lbs. #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 Clean&Service Clean&Service Check Valve Check Valve FINAL CLOSED TIGHT® CLOSED TIGHT ® CLOSED TIGHT C1TEST #LBS 1.4 #LBS I.4 OPENED AT_LBS OPENED AT LEIS #UBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY �— CERTIFIED TESTER N0.2656 DATE,1/21/05 MO. DAY YR. . REPAIRED BY �- DATE 1/21/05 FINAL TEST BY � CERTIFIEDTESTER NO. 2656 DATEI/21/05. MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS gas '" 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 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650 --C=FINED SERVICE ADDRESS 20450 Stevens Creek Blvd.,Cu ertino/X-De Anza Blvd. ax MAILING ADDRESS Prometheus CONTACT Bob 20400 Stevens Creek Blvd.,4245 TEL# 410-6517 ,�1 Cupertino,CA 95014 �"� 5 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009M2QT RP 1 186607 INTERNAL ® TAG LOCATION OF DEVICE roof boiler makeup EXTERNAL ❑ IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX PASS FAIL❑ •� REDUCED PRESSURE DEVICES PRESSURE TYPE - - DOUBLE CHECK VALVES - - - VACUUM BREAKERS RPP VALVES DIFFERENTIAL ' CHECK VALVE CHECK VALVE PRESSURE/RELIEF VALVE AIR INLET CHECK VALVE N0.1 N0.2 CLOSED TIGHT CLOSED TIGHT OPENED AT 3 . n LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL #lbs.�, U lbs. #LBS #LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN Cl OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT Cl CLOSED TIGHT ❑ CLOSED TIGHT❑ TEST #LBS #LBS OPENED AT_LBS OPENED AT_LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE t , � I- INITIAL TEST BY ��- 10866 CERTIFtEDTESTER�NO. DATE I-9-06 . .. __i .. . . .. < -MO. DAY YR. 1 REPAIRED BY - - - - - - - ...DATE _... .... .... FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS gFa4t CROSS CONNECTION SPECIALISTS ',1♦ BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 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 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-265 SERVICE ADDRESS 20450 Stevens Creek Blvd.,Cu ertino/X-De Anza Blvd. JAN 1 8 2006 MAILING ADDRESS Prometheus CONTACT Bob 20400 Stevens Creek Blvd.,#245 TEL# 410-6517 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC V R6070 INTERNAL ® TAG LOCATION OF DEVICE roof chiller water make up line EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASSA[ 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 CLOSEDTIGHT CLOSEDTIGHT OPENEDAT_LBS. OPENEDAT_.LBS CLOSED TIGHT ❑ INITIAL •lba. lbs. Z, e!:P #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 FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ CLOSED TIGHT❑ TESTOPENED AT_LBS OPENED AT_LBS iLBS #LBS tLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE - INITIAL TEST BY CERTIFIED TESTER NO. 10866 DATE 1-9-06 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. - a CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS I NSTALLATI ON•REPAIRS-TESTING-CERTIFICATION • d 7N BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800) - I[OYV-( IVSD 3750-E CHARTER PARK DR.,SAN JOSE CA 95138-1356 (408)269-2600 3608 FERNVJOOD ST.,SAN MATED CA 94403 FAX(408)269-2650 JAN 1 3 2006 SERVICE ADDRESS 20450 Stevens Creek Blvd.,Cu ertino/X-De Anza Blvd. Y� MAILING ADDRESS Prometheus CONTACT Bob 20400 Stevens Creek Blvd.,#245 TEL# 410-6517 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC 2„ R9877 INTERNAL ® - TAG LOCATION OF DEVICE roof cooling tower heat exchanger make up water EXTERNAL ❑ 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 I RELIEF -NO.1 NO.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENEDAT_LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL #ICs. c #Its.16 #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 FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ Y a CLOSED TIGHT❑ OPENED AT_LBS OPENED AT_LBS TEST IF LBS *LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY UCS i CERTIFIED TESTER NO. 10866 GATE 1-09-06 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ,g�X/+�°0°' CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'i' 'i' BACKFLOW PREVENTION VALVE EXPERT PRESSURE TYPE Shutoff Valves INSTALLATION -REPAIRS -TESTING -CERTIFICATION CALIFORNIA (800) 464 -FLOW (3569)��� VACUUM BREAKERS LOCAL (408) 269-2600 S qwe. LICENSED CONTRACTOR C.C.L.# 427328 I FAX (408) 269-2650 QO�O 3750-E CHARTER PARK DR„ SAN JOSE CA 95136-1356 %ACKFLOW PREVENTION SPECIALISTS, INC. MAILING/OWNER Cupertino City Center Bldgs Address 20400 Stevens Creek Blvd #230 rx�' CA. 95014 CONTACT: Bob Camarda MANUFACTURER MODELNUME Watts 009M2QT NEW INSTALLATION: REPLACEMENT: REPLACEMENT DEVICE INFORMATION MANUFACTURER MODELNUMBER INTERNAL EXTERNAL❑ Hazard Type: 0' METER # TAG # SERVICE Cupertino City Center Bldgs ADDRESS 20450 Stevens Creek Blvd. CA. 95014 ! a ZLTLEL# 40� 410-6517 TYPE SIZE SERIAL NUMBER Rp--JJ'--I 1., 186607 TYPE SIZE SERIAL NUMBER _Roof boiler makeup :Zd y60 AY—Z-# Comments: THE ABOVE REPORT IS CERTIFIEP2UE TRUE ITIAL TEST BY` CERTIFIED TESTER NO. 10866 a REPAIRED BY DATE PASS DATE W-07-07 FAIL MO. DAY YR. PASS ❑ FINAL TEST BY CERTIFIED TESTER NO. DATE FAIL ❑ MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE AIR INLET CHECK VALVE PRESSURE/RELIEF NO.1 NO.2 VALVE #1 #2 CLOSED TIGHT T CLOSED TIGHT ' n OPENED ATZ2 LBS. OPENED AT_LBS CLOSED TIGHT❑ CLOSED TIGHT INITIAL X lbs. 7. 2 # lbs. OPENED UNDER 1.0 # LBS. LEAKED ❑ ❑ TEST OPENED UNDER 2.0 DR DID NOT OPEN ❑ LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT❑ OPENED A7_XIBS PENED AT_XLB CLOSED TIGHT ❑❑ TEST gLBS ALBS XLBS Comments: THE ABOVE REPORT IS CERTIFIEP2UE TRUE ITIAL TEST BY` CERTIFIED TESTER NO. 10866 a REPAIRED BY DATE PASS DATE W-07-07 FAIL MO. DAY YR. PASS ❑ FINAL TEST BY CERTIFIED TESTER NO. DATE FAIL ❑ MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS CALIFORNIA (800) 464 -FLOW (3569) LOCAL (408) 269-2600 FAX (408) 269-2650 %ACKFLOW PRE' MAILING / OWNER Cupertino City Center Bldgs Address 20400 Stevens Creek Blvd #230 CA. 95014 CONTACT: Bob Camarda � , - BACKFILOW P EVENT ON SPECIALISTS EXPERT 1� INSTALLATION -REPAIRS -TESTING -CERTIFICATION Sp« �qfa• LICENSED CONTRACTOR C.C.L.# 427326 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 NTION SPECIALISTS, INC. Cupertino City Center Bldgs 20450 Stevens Creek Blvd. Cupertino, CA. 95014 -410-6517 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC I" R6070 NEW INSTALLATION: ❑ REPLACEMENT: U REPLACEMENT DEVICE INFORMATION MANUFACTURER MODELNUMBER- TYPE SIZE SERIAL,NUMBER INTERNAL ® METER # EXTERNAL ❑ TAG # Hazard Type: • LOCATION OF DEVICE Roof chiller water makeup line BL tJ 247VS'O Comments: THE ABOVE REPOR RUE oITIAL TEST BY�� \�—� CERTIFIED TESTER N0, 10866 REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO, PASS DATE 02-07-07 FAIL ri MO. DAY YR. PASSE DATE FAIL ❑ MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE AIR INLET CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE #1 #2 CLOSED TIGHT jot CLOSED TIGHT OPENED AT _ LBS. OPENED AT—LBS CLOSED TIGHT ❑ CLOSED TIGHT INITIAL # Ibs. 2 • 72- #lbs. 2 • :` LEAKED ❑ ❑ OPENED UNDER 1.0 # LBS. TEST OPENED UNDER 2.0 OR DID NOT OPEN ❑ ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ LEAKED REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ LOSED TIGHT❑ OPENED AT #LBS OPENED AT #LB�ICL CLOSED TIGHT❑❑ TEST gLBS ALBS BS Comments: THE ABOVE REPOR RUE oITIAL TEST BY�� \�—� CERTIFIED TESTER N0, 10866 REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO, PASS DATE 02-07-07 FAIL ri MO. DAY YR. PASSE DATE FAIL ❑ MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS CALIFORNIA (800) 464 -FLOW (3569) LOCAL (408) 269-2600 FAX (408) 269-2650 %ACKFLOW PREVE MAILING / OWNER Cupertino City Center Bldgs Address 20400 Stevens Creek Blvd #230 JAY• Cupertino, CA. 95014 CONTACT: Bob Camarda CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 ;E-CIALISTS, INC. 1 I SERVICE Cupertino City Center ADDRESS 20450 Stevens Creek 1 = --Cupertino, CA. 95014 TEL# 408-410-6517 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC 2" R9877 NEW INSTALLATION: REPLACEMENT: F REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER INTERNAL ® METER EXTERNAL ❑ TAG # Hazard Type, • LOCATION OF DEVICERoof cooling tower heal exchanger make up water Comments: THE ABOVE REPORT ISSCCEC E TRUE �ITIAL TEST B /y CERTIFIED TESTER NO. 10866 REPAIRED BY DATE FINAL TEST BY PASS DATE 02-07-07 FAIL MO. DAY YR. CERTIFIED TESTER NO, DATE MO. DAY YR. PASS ❑ FAIL ❑ REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE AIR INLET CHECK VALVE PRESSURE/RELIEF NO.1 NO.2 VALVE a1 T#72 CLOSED TIGHT CLOSED TIGHT X OPENED AT_ LBS. OPENED A7_LSS CLOSED TIGHT ❑ CLOSEDTIGHT18 W INITIAL # lbs. Z -o # Ibs.7 # LBS. LEAKED ❑ ❑ Z OPENED UNDER 1.0 TEST -&� OPENED UNDER 2.0 R DID NOT OPEN ❑ LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSEDTIGHT❑ OPENED AT_MLSS PENEO AT_MLB CLOSED TIGHT C1 TEST #LBS #LBS # LBS Comments: THE ABOVE REPORT ISSCCEC E TRUE �ITIAL TEST B /y CERTIFIED TESTER NO. 10866 REPAIRED BY DATE FINAL TEST BY PASS DATE 02-07-07 FAIL MO. DAY YR. CERTIFIED TESTER NO, DATE MO. DAY YR. PASS ❑ FAIL ❑ CERTIFICATION OF RE-CLAIMED WATER SYSTEMS �Ac6�°°' bbsyryt CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'i' 'E' BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION CALIFORNIA (800)464-FLOW(3569) -- LOCAL(408)269-2600 g Ct>�I}1 TRACTOR C.C.L.#427328 FAX(408)269-2650 E I{qp K DR.,SAN JOSE CA 95136-1356 BACKFLOW PREVENTION PE�bA► STS INC. MAILING/OWNER Cupertino City Center Bldgs SER no-Cit -Center Id s Address 20400 Stevens Creek Blvd#230 ADD 20450 Stevens Cree Ivd. Cupertino,CA. 95014 Cupertino,CA.95014 CONTACT:Bob Camarda TEL# 408-410-6517 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC I" R6070 NEW INSTALLATION: REPLACEMENT:❑ REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE Roof chiller water make up line,Bldg.#20450 INTERNAL ® METER# EXTERNAL❑ TAG If Hazard Type:chiller makeup • REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF , AIR INLET CHECK VALVE NOA NO.2 VALVE #1 #2 CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT_LBS. OPENED AT—LBS CLOSED TIGHT❑ CLOSEDTIGH INITIAL #lbs. #lbs. O NO #LBS. LEAKED 11 ❑ DIDNO R DID NOT OPEN TEST OPENED UNDER 2.0 [ ❑ LEAKED LEAKED OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS 'let t� I AND "� l,(,( MATERIALS USED - �..._ 1Sq FINAL CLOS TIGHT CLOSED TIGHTCLOSED TIGHT TEST LBS %), � X #LBS_i # (� ❑ OPENED AT #LBS_ OPENED AT #LB CLOSED TIGHT q #LBS Comments: THE ABOVE REPORT IS CERTIFIED TO BE TRUE PASS ❑ �ITIAL TEST BY�� � ' CERTIFIED TESTER N0, 11277 DATE 02/14/08 FAIL n MO. DAY YR. REPAIRED BY /"N1 V v ' DATE I D PASS { FINAL TEST BY '7"� CERTIFIED TESTER NO. 112,17 DATE / I I FAIL ❑ MO. DAY YR. t CERTIFICATION OF RE-CLAIMED WATER SYSTEMS "°' CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'i' .,� 'i' BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION CALIFORNIA (800)464-FLOW(3569) • LOCAL(408)269-2600 $ 9.0, LICENSED CONTRACTOR C.C.L.#427328 FAX(408)269-2650 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIALISTS, INC. MAILING/OWNER Cupertino City Center Bldgs SERVICE Cupertino City Center Bldgs Address ADDRESS 20400 Stevens Creek Blvd#230 20450 Stevens Creek Blv . Cupertino,CA.95014 Cupertino,CA. 95014 CONTACT;Bob Camarda TEL# 408-410-6517 VE 1 9 2008 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009M1 RP 2" B NEW INSTALLATION:❑ REPLACEMENT:❑ REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE park pool INTERNAL ❑ METER# 40958799 EXTERNAL® TAG# Hazard Type: • REDUCED PRESSURE DEVICES PRESSURE TYPE ,Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF AIR INLET CHECK VALVE N0.1 N0,2 VALVE a1 a2 CLOSED TIGHT ® CLOSED TIGHT ® OPENED AT 2.8 LBS. OPENED AT—LBS CLOSED TIGHT C1 CLOSED TIGHT ❑ INITIAL p lbs. 8.2 #lbs. OPENED UNDER 1.0 a LBS. LEAKED ❑ ❑ TEST OPENED UNDER 2.0 R DID NOT OPEN❑ LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ KB CLOSED TIGHT C1 OPENED AT_pLBs OPENED AT CLOSED TIGHT❑ ❑ TEST pLBs pLBs pLBs Comments: THE ABOVE REPORT IS CERTIFIED TO BE TRUE PASS 'V�r`�� CERTIFIED TESTER NO. 11277 DATE01/31/08 FAIL ITIALTESTBV / ❑ M0. DAY YR. REPAIRED BY DATE PASS ❑ FINAL TEST BY CERTIFIED TESTER NO. DATE FAIL ❑ MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS t6�"P" CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'i" , 'i' BACKFLOW PREVENTION VALVE EXPERT CALIFORNIA (800)464-FLOW(3569) I� INSTALLATION-REPAIRS-TESTING-CERTIFICATION • LOCAL(408)269-2600 SSS LICENSED CONTRACTOR C.C.L.#427328 FAX(408)269-2650 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIALISTS, INC. MAILING/OWNER Cupertino City Center Bldgs SERVICE Cupertino City Cent"r s Address -- ADDRESS 20400 Stevens Creek Blvd#230 20450 Stevens Cree Cupertino,CA. 95014 Cupertino,CA. 950 CONTACT:Bob Camarda - TEL# 408-410-6517 MANUFACTURER MODELNUMBER TYPE SIZE Watts 009M1 RP 2" 233859 NEW INSTALLATION:❑ REPLACEMENT: REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE park pool INTERNAL Cl METER# 31886218 EXTERNAL® TAG It Hazard Tvoe: • REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF AIR INLET CHECK VALVE N0.1 N0.2 VALVE at a2 CLOSED TIGHT ® CLOSED TIGHT ® OPENED AT 2.4 LBS. OPENED AT LBS CLOSED TIGHT❑ CLOSED TIGHT ❑ INITIAL p Ibs. 8.0 a tbs. , OPENED UNDER 1.0 a LBS. LEAKED ❑ ❑ TEST OPENED UNDER 2.0 R DID NOT OPEN Cl LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT Cl CLOSED TIGHT Cl pL9 CLOSED TIGHT❑ _ TEST pLBS pLBS OPENED AT #LBSTPENED AT CLOSED TIGHT C] pLBS Comments: THE ABOVE REPORT IS CERTIFI9T7�� 11277 DATE 01/31/08 PASS CERTIFIED TESTER NO. FAIL NITIAL TEST BY / ❑ MO. DAY YR. REPAIRED BY DATE PASS ❑ FINAL TEST BY CERTIFIED TESTER NO, DATE FAIL ❑ MO. DAY YR. - CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ,RANfi�p°" 1°aY4 CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'E' Y BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION CALIFORNIA (800)464-FLOW(3569) • LOCAL(408)269-2600 Sp q,#e• LICENSED CONTRACTOR C.C.L.#427328 FAX(408)269.2650 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIA 91 MAILING/OWNER Cupertino City Center Bldgs SERVICE Cupertino City Cen fi ldpq Address ADDRESS 20450 Stevens Cre Iv . 20400 Stevens Creek Blvd#230 Cupertino,CA.95014 Cupertino, A.954.14 CONTACT:Bob Camarda TEL# 408-410-6517 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009M2QT RP 1"' 186607 NEW INSTALLATION: REPLACEMENT: REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE Root boiler make up,Bldg.#20450 INTERNAL ® METER# EXTERNAL❑ p TAG# Haza� `K�-u t Lw REDUCED PRESSURE DEVICES PRESSURE TYPE Shuloft Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF AIR INLET CHECK VALVE NO.1 NO.2 VALVE #1 #2 CLOSED TIGHT Ey CLOSED TIGHT �91 OPENED AT2_1�i LBS. OPENED AT LES CLOSED TIGHT❑ CLOSED TIGHT❑ INITIAL p lbs. r #lbs. , OPENED UNDER I.O #LBS. LEAKED ❑ ❑ TEST OPENED UNDER 2.0 OR DID NOT OPEN Cl LEAKED Cl LEAKED Cl OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT Cl CLOSED TIGHT ❑ CLOSED TIGHT TEST gLBS gLBS ❑ OPENED AT_#LBS OPENED ATpLB_ CLOSEDTIGHT❑ � pLBS Comments: • THE ABOVE REPORT IS CERTIFIED Tq BE TRUE LS DATE 01/31/08 FAI INITIAL TEST BY I CERTIFIED TESTER NO. 11277 ❑ MO. DAY YR. REPAIRED BY DATE PASS ❑ FINAL TEST BY CERTIFIED TESTER NO, DATE FAIL ❑ MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS rcb�p01 CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 't' Y" BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION CALIFORNIA (800)464-FLOW(3569) �� • LOCAL(408)269-2600 S� . LICENSED CONTRACTOR C.C.L.#427328 FAX(408)269-2650 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIALISTS, INC. MAILING/OWNER Cupertino City Center Bldgs SERVICE Cupertino City Center Bldgs Address ADDRESS 20400 Stevens Creek Blvd#230 20450 Stevens Creek B Cupertino,CA. 95014 Cupertino,CA.95014 CONTACT:Bob Camarda TEL# 408-410-6517ER19 2008 MANUFACTURER MODEL NUMBER TYPE SIZE '=SERIAL NUMBER Febco 805Y DC I" By R6070 NEW INSTALLATION: REPLACEMENT: REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE Roof chiller water make up line, Bldg.#20450 INTERNAL ® METER# EXTERNAL❑ TAG# Hazard T e: GV 1 I I `or REDUCED PRESSURE DEVICES PRESSURE TYPE ShutoN Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF AIR INLET CHECK VALVE NO.1 NO.2 VALVE #1 #2 CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT_LBS. OPENED AT LBS CLOSED TIGHT CLOSED TIGHVId INITIAL #lbs. #lbs. x LBS LEAKED ❑ ❑ TEST OPENED UNDER 2.0 OPENED UNDER 1.0 R DID NOT OPEN❑ LEAKED ❑ LEAKED OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ xLB CLOSED TIGHT TEST xLBS xLBS ❑ OPENED AT_#LBS �PENED AT CLOSED TIGHT❑ ❑ ALBS Comments: V lr. Lk-j4w. L VL©,-�— kw all, 10 r THE ABOVE REPORT IS CERTIFIED TO BE TRUE Y PASS ❑ NITIAL TEST By CERTIFIED TESTER NO. 11277 DATE 0I/31/08 FAIL MO. DAV YR. REPAIRED BY DATE PASS ❑ FINAL TEST BY CERTIFIED TESTER NO. DATE FAIL ❑ MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS N6�°O' CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS Y' .,, 'T' BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION • CALIFORNIA (800)464-FLOW(3569) LOCAL(408)269-2600 $ . LICENSED CONTRACTOR C.C.L.#427328 FAX(408)269-2650 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIALI MAILING/OWNER Cupertino City Bldgs Center BldSERVICE Cupertino City Center BI Address 20400 Stevens Creek Blvd#230 ADDRESS 20450 Stevens Creek BIVAJU 2008 Cupertino,CA.95014 Cupertino,CA. 95014 CONTACT:Bob Camarda TEL# 408-410-6517 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC 2" R9877 NEW INSTALLATION:❑ REPLACEMENT:❑ REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE Roof cooling tower heat exchanger make up water, Bldg. INTERNAL ® METER# #20450 EXTERNAL❑ TAG If Hazard.Tlr�e_: CoD VI REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF AIR INLET VALVE CHECK VALVE N0.1 N0.2 X1 # CLOSE TIGHT CLOSED TIGHT �^� OPENED AT_LBS. OPENED AT LBS CLOSED TIGHT❑ CLOSED TIGHT INITIAL X tbs. N _ #tbs. #LBS. LEAKED ❑ ❑ TEST OPENED UNDER 2.0 OPENED UNDER 1,0 R DID NOT OPEN ElLEAKED ClLEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ XLB CLOSED TIGHT❑ OPENED AT_XLBS PENED A7 CLOSED TIGHT❑ ❑ TEST XLBS XLBS NLBS Comments: ( Q t/L ( C9 a II/k ( � 1�/�V—. C a11Qj9A1QJ-r_ ,- lel(, 14 (n zu-v-d S 11Y X9-iA :. THE ABOVE REPORT IS CERTIFIE 0 BE TRUE DATE 01/31/08 FAILS IN ITIAL TEST BY \ CERTIFIED TESTER N0. 11277 ❑ MO. DAY YR. REPAIRED BY DATE - PASS ❑ FINAL TEST BY CERTIFIED TESTER NO. DATE FAIL ❑ MO. DAY YR.