Backflow PreventionCERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS
CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS a,
BACKFLOW PREVENTION VALVE EXPERT
INSTALLATION -REPAIRS -TESTING -CERTIFICATION
S+ya�iCGr�QiW
%ACKFLOW 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
FAX (408) 269-2650
3608 FERNWOOD ST., SAN MATEO CA 94403
DIFFERENTIAL
•
SERVICE ADDRESS 23025 Voss Ave., Cupertino/X-Footltill Blvd
MAILING ADDRESS ROber(o Luna
23025 Voss Ave.
Cupertino, CA 95014
MANUFACTURER MODEL NUMBER TYPE
Watts
909M2QT - -- —
. RP -
CONTACT Roberto
TEL# 255-2402
SIZE
1 1/2"
INTERNAL ❑ TAG LOCATION OF DEVICE mtr# 29718983 -
EXTERNAL
IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[:] PASS FAIL❑
SERIAL NUMBER
29718983
V D
2004
THE ABOVE REPORT IS CERTIFIED TO BE TRUE
INITIAL TEST BY / "� �' CERTIFIED TESTER'NO. 9815 DATE `4-28-04
.7,.,.. ^d..
MO. DAY YR.
REPAIRED BY /u �/CM„6LQC0 DATE V, 7 ' Q
FINAL TEST BV/�// •//_� CERTIFIED TESTER NO. ( O DATE �- .7 O "� y
MO. DAY YR.
REDUCED PRESSURE DEVICES
11.- � . e.
_ 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 LBS.
OPENED AT_LBS
CLOSED TIGHT ❑
INITIAL
pIba.
0lbs.
#LBS
#LBS.
TEST
OPENED UNDER 2.0
OPENED UNDER 1.0
LEAKED AJ
LEAKED ❑
OR DID NOT OPEN ❑
OR DID NOT OPEN ❑
LEAKED Cl
^y/
REPAIRS
AND
,,//`S
0/ SC SOCK
MATERIALS
5 )1 vC
USED
Ckecl�
FINAL
CLOSrcD TI HT
CLOSED TIGHT
�1 (f
CLOSED TIGHT ❑
TEST
pLBS (Q L
#LBS
OPENED AT O�`-I LBSrOPENEDAT—LBS
I LBS -
THE ABOVE REPORT IS CERTIFIED TO BE TRUE
INITIAL TEST BY / "� �' CERTIFIED TESTER'NO. 9815 DATE `4-28-04
.7,.,.. ^d..
MO. DAY YR.
REPAIRED BY /u �/CM„6LQC0 DATE V, 7 ' Q
FINAL TEST BV/�// •//_� CERTIFIED TESTER NO. ( O DATE �- .7 O "� y
MO. DAY YR.