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Blackflow Prevention Specialists 9/22/2004CROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS G'".�"'" .E. BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS ^ +�._,}� INSTALLATION -REPAIRS -TESTING -CERTIFICATION . Sikiwrll�te she., ,�-v Z�� T D%ACKFLOW PREVENTION SPECIALI Tsb�121j,. LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 484 -FLOW (3569) 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 (408) 269-2600 �: 1522-A DAY AVE., SAN MATEO CA 94403 FAX (4138) 269-2650 • SERVICE ADDRESS 10200 S De Anja Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir., Ste. 150 TEL# (650)280-W48 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XL RP 3/4° 612975 INTERNAL ® TAG LOCATION OF DEVICE boiler roof EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSIM FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY _ �CERTIFIED TESTER NO. j(U d b DATE 9-20-04 MO. DAY YR. • REPAIRED BY . FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF VALVE AIR INLET CHECK VALVE NO.1 NO.2 CLOSED TIGHT CLOSED TIGHT OPENED AT 3a LBS. OPENED AT LBS CLOSED TIGHT ❑ INITIAL #lbs. #ibs. _ *LBS ALBS. 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 ❑ TEST OPENED AT_LBS OPENED AT_LES pLBS #LBS pIBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY _ �CERTIFIED TESTER NO. j(U d b DATE 9-20-04 MO. DAY YR. • REPAIRED BY . FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ,�jw<o.mtt:'+,w%a--� CROSS CONNECTION SPECIALISTS -f-. ; -�- x BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS -���- '" INSTALLATION -REPAIRS -TESTING -CERTIFICATION %ACKFLOW PREVENTION SPECIALIS ;` NCI. • LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 SERVICE ADDRESS 10200 S De Anna Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman�er 3975 Freedom Cir., Ste. 150 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE Willdns 975XL RP INTERNAL ® TAG EXTERNAL Cl CALIFORNIA (804)4eI L��,3A9�004 (408) 269-2600 FAX (408) 269-26 CONTACT Anthony TEL# (650) 280-0048 LOCATION OF DEVICE Chi11Cr roof SIZE SERIAL NUMBER. 1 552186 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PASSZFAILO THE ABOVE REPORT IS CERTIFIED TO BE TRUE REDUCED PRESSURE DEVICES INITIAL TEST BY \ CERTIFIED TESTER 14C v V PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE / RELIEF NO.1 NO.2 VALVE AIR INLET CHECK VALVE CLOSE IGHT CLOSED TIGHT OPENED ATLBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL A Ibs. 12 # tbs. #LBS A 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 Cl_ TEST ALBS ALBS OPENED AT LBS OPENED AT _ LBS iLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY \ CERTIFIED TESTER 14C v V REPAIRED BY • FINAL TEST BY DATE CERTIFIED TESTER NO, DATE 9-20-04 MO. DAY YR. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS " " ''""'` "",�' � BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'b, ta,'` INSTALLATION -REPAIRS -TESTING -CERTIFICATION ' SlkK46fata�%�' 98ACKFLOW PREVENTION SPECIALISTS LICENSED CONTRACTOR C.C.L.4 427328 CALIFORNIA (800) 464-F OWW(3%9)-'F''I V� 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 FAX)(269-408) 269-2850 SEP 2 6 2004 3608 FERNWOOD ST., SAN MATEO CA 94403 • SERVICE ADDRESS 10200 S. De Area Blvd. MAILING ADDRESS Tishman Creek Blvd 3975 Freedom Cir., Ste. 150 i Santa Clara, CA 95054 MANUFACTURER �,• MODEL NUMBER TYPE Watts 909 RP INTERNAL ® TAG EXTERNAL Cl CONTACT AnthODY TEL# (650) 280-0048 SIZE SERIAL NUMBER 3/4" 522990 LOCATION OF DEVICE Chiller roof in boiler room IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY ,� �`— CERTIFIED TESTER NO. � I OQA O DATE 9-20-04 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. 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 OPENEDATI LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL #Ibs.q. OL_ #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 \A FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑CLOSED TIGHT ❑ TEST pLBS ALBS OPENED AT _LBS OPENED AT_LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY ,� �`— CERTIFIED TESTER NO. � I OQA O DATE 9-20-04 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. ,, CROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS Y+"--"" -'tee BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS - INSTALLATION-REPAIRS-TESTIN�'�y IIY�.7}r�p� SEP 2 8 2004 %ACKFLOW PREVENTION SPECIALI$,TS, 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 10200 S De Anza Blvd., CBpertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir., Ste. 150 TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XL RP 2° 534994 INTERNAL ® TAG LOCATION OF DEVICE Cooling tower roof EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS2 FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIALTESTBY CERTIFIED TESTER NO, _L02.V DATE 9-20-04 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE l RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLO ED TIGHT CLOSED TIGHT OPENED AT LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL #lbs. 0 #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 FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT❑ TEST #LBS #LBS OPENEDAT_LBS OPENED AT LBS _ #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIALTESTBY CERTIFIED TESTER NO, _L02.V DATE 9-20-04 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS a `,,xnn.,^-a+.`4e CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT ;. re°', INSTALLATION -REPAIRS -TESTING -CERTIFICATION %ACKFLOW PREVENTION SPECIALIST% ]P�O,C. 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)269-2850 • SERVICE ADDRESS 10200 S De Alva Blvd., CBpertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir., Ste. 150 TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODELNUMBER TYPE Febco 825YA RP INTERNAL ❑ TAG EXTERNAL LOCATION OF DEVICE SIZE 2" mtrk 40418232 at Portal IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSO FAIL❑ SERIAL NUMBER A021844 THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.—"02.0 DATE 9-20-04 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. T REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE / RELIEF VALVE AIR INLET CHECK VALVE NO.1 NO.2 CLOSED TIGHT CLOSED TIGHT OPENED AT jj— LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL #Ih"..fir .. #Ihs. #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 CLOSEOTIGHT ❑ CLOSED TIGHT❑ OPENEDAT_LBS OPENED AT LBS TEST NUBS #LBS _ #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.—"02.0 DATE 9-20-04 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. T d CROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS Haas-�w - �- BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS -,r `. u. --� INSTALLATION -REPAIRS -TESTING -CERTIFICATION ER` %ACKFLOW PREVENTION SPECIALIFmir!;569), ,INC. LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 464!-FT 64E _ 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 (408) 269-2600 J 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269-2650 171 • SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT AnthOnY 3975 Freedom Cir., Ste. 150 TEL# (650) 280.0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 825YA RP 2" A021891 INTERNAL ❑ TAG LOCATION OF DEVICE iffigation mtr# 60112835 at Portal EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS 2 FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.�DATE 9-20-04 MO. DAY YR. REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. 4 REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF VALVE AIR INLET CHECK VALVE N0.1 N0.2 CLOSED TIGHT CLOSED TIGHT OPENED AT 2,L-QLBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL 0Ibs. 71 6 0Ibs. #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 ❑Y' TEST#LBS #LBS OPENED AT_LBS OPENED AT_UBS tLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.�DATE 9-20-04 MO. DAY YR. REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. 4 CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ,�s$Y. CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'E' • T' BACKFLOW PREVENT LV EXPERT INSTALLATION-REPAI I�O= Tl-fJCA7Ql s�qw SEP 2 g 2004 OBACKFLOW PREVENTION SPECIAL 6TS 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 0 .0 SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman. Speyer 3975 Freedom Cir., Ste. 150 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE Wilkins 975 RP INTERNAL ❑ TAG EXTERNAL CONTACT Anthony TEL# (650)280-0048 SIZE SERIAL NUMBER 3"B22660 LOCATION OF DEVICE mail mtr# 60112842 al Portal IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BV CERTIFIED TESTER NO. _1 0 W DATE 9-20-04 MO. DAY YR, REPAIRED BY FINAL TEST BY LAmr4 CERTIFIED TESTER NO. DATE MO. DAY YR. 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 J/ CLOSED TIGHT (}' OPENEDATIIQ LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL alba. g. �)_ #Ibs. OLDS #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 11TEST #LBS #LBS OPENEDAT_LBS _ OPENED AT LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BV CERTIFIED TESTER NO. _1 0 W DATE 9-20-04 MO. DAY YR, REPAIRED BY FINAL TEST BY LAmr4 CERTIFIED TESTER NO. DATE MO. DAY YR.