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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.