The URL can be used to link to this page

Blackflow Prevention Specialists 9/24/2005JN OF RE-CLAIMED WATER SYSTEMS SS CONNECTIO CROSS CONNECTION CONTROL CONSULTANTS,, BACOKFLOW PREVENTIONEVAALVIE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.# 427328 '3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 CALIFORNIA (800) 464 -FLOW (3569) 1522-A DAY AVE., SAN MATEO CA 94403 (408) 269-2600 FAX(408)269-2650 SERVICE ADDRESS 10200 S. De Anza Blvd., Cupertino -C V I MAILING ADDRESS Tishman Speyer CONTAC Anthon 444 Castro St., Ste. 520 nv. _ TEL# 65d-280-Ob48 Mountain View, CA 94041 MANUFACTURER MODEL NUMBER TYPE Watts 909 SIZE SERIAL NUMBER PIP 3/4" 522990 INTERNAL - TAG LOCATION OF DEVICE Chiller Roof in boiler room EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 • PASS • FAIL[] REDUCED PRESSURE DEVICES DOUBLE CHECK VALVES PRESSURE TYPE RPP VALVES DIFFERENTIAL VACUUM BREAKERS CHECK VALVE CHECK VALVE PRESSURE/RELIEF NO.1 NO.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT CLOSED TIGHT OPENED AT 0(,/ INITIAL a lbs. Z_ LBS. OPENED #lbs. AT,__ LBS CLOSED TIGHT ❑ TEST UNDER 2.0 LEAKED C) #LBS MLBS OPENED UNDER 1.0 LEAKED LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND USED I FINAL I CLOSED TIGHT C1I CLOSED :TIGHT C01 TEST tlLBS OPENED AT %LBS LBS OPENED THE ABOVE REPORT IS CERTIFIED TO BE TRUE a CLOSED TIGHT ❑ 1 LBS INITIAL TEST BY -- — CERTIFIED TESTER NO,�-1 �t /�_ DATE AIRED BY MO. DAY YR. DATE FINAL TEST BY CERTIFIED TESTER N0. _. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ° ,; CROSS CONNECTION SPEQIAVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS , BACKFLOW PREVENTION,VATIN E INSTALLATION -REPAIRS -TESTING -CERTIFICATION • `SMa6s�sts�4w°' . BACKFLOW PREVENTION SPECIALISTS, INC. • LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136.1356 1522-A DAY AVE.. SAN MATEO CA 94403 SERVICE ADDRESS 10200 S De Anja MAILING ADDRESS TiShmazt 3975 Freedom Cir., 1st floor Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE Wilkins 975XL RP INTERNAL ® TAG EXTERNAL ❑ CALIFORNIA ( (408) 269-2600 FAX (408) 269; CONTACT TUU/UUY TEL# (650) 280.0048 LOCATION OF DEVICE boiler roof SIZE SERIAL NUMBER 3/4" 612975 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX El PAS9l FAIL❑ THE ABOVE REPORT IS CERTIFIED /TOO�I BE TRUE ' n INITIALTESTBY 1� W�X..H/�_—CERTIFIED TESTER NO, 9815 DATE 9-18-03 • REPAIRED BY iA9 MO. DAY YR. FINAL TEST BY 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 ry� CLOSED TIGHT {.] CLOSED TIGHT �� OPENED AT y�.XLBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL # tbs. q - 151) t ` # Ibs. #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 OPENED AT _LBS OPENED AT _ LBS #LBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED /TOO�I BE TRUE ' n INITIALTESTBY 1� W�X..H/�_—CERTIFIED TESTER NO, 9815 DATE 9-18-03 • REPAIRED BY iA9 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 71 INSTALLATION -REPAIRS -TESTING -CERTIFICATION • BACKFLOW PREVENTION SPECIALISTS, INC. • LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 1522-A DAY AVE.. SAN MATEO CA 94403 SERVICE ADDRESS MAILING ADDRESS Tishman Speyer 3975 Freedom Cir., 1st floor Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE Willdns 975XL RP INTERNAL ® TAG EXTERNAL ❑ CALIFORNIA (600) (408) 269.2600 FAX (408) 269-265L CONTACT Anthony TEL# (650) 280-0048 LOCATION OF DEVICE chiller roof SIZE SERIAL NUMBER V 552186 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PAS 15x FAIL❑ • THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY,. -LA CERTIFIED TESTER NO, 9815 DATE 9-18-03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIEDTESTER NO. DATE MO. DAY YR. 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 CHECKVALVE CLOSEDTIGHT CLOSED TIGHT OPENEDAT�LBS. OPENEDAT_LBS CLOSEDTIGHT C1INITIAL alba. #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 p LBS ALBS OPENED AT I_LBS OPENED AT _LBS 8Lgg • THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY,. -LA CERTIFIED TESTER NO, 9815 DATE 9-18-03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIEDTESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS 1 CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS I N STALLATIO N•R EPAI R S -TESTI N G -CERTIFICATION • SAw4llar� ?1W BACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 1522-A DAY AVE., SAN MATEO CA 94403 SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyet 3975 Freedom Cir., 1st floor Santa Clara, CA 95054 MANUFACTURER MODELNUMBER TYPE Wilkins 975XL RP INTERNAL ® TAG EXTERNAL ❑ CALIFORNIA (408) 269-26( FAX (408) 26 CONTACT AnthO11y TEL# (650) 280-0048 LOCATION OF DEVICE Cooling tower roof SIZE SERIAL NUMBER 2" 534994 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PAS# FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST B� CERTIFIED TESTER NO. 9815 DATE 9-18-03 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 CLOD TIGHT CLOSED TIGHT OPENED AT `_'RBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL # Ibs. # be. #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 El CLOSED TIGHT El CLOSED TIGHT Cl OPENED AT_LES OPENED AT TEST #LBS #LBS _LBS *LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST B� CERTIFIED TESTER NO. 9815 DATE 9-18-03 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 'PS""° BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS . _,,a� INSTALLATION -REPAIRS -TESTING -CERTIFICATION • ��//SMurliw�9re BACKFLOW PREVENTION SPECIALISTS, INC. • LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 1522-A DAY AVE.. SAN MATEO CA 94403 CALIFORNIA (800)464-F(3569}-' " FAX(40e269--2650 SEP 2 4 2003 SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek BY MAILING ADDRESS Tishman Speyer CONTACT AnthonY 3975 Freedom Cir., 1st floor Santa Clara, CA 95054 MANUFACTURER MODELNUMBER TYPE Feboo INTERNAL ❑ TAG EXTERNAL E3�.�Yal 0 TEL# (650)280-0048 SIZE SERIAL NUMBER 2" A021844 LOCATION OF DEVICE irrigation mtr# 40418232 at Portal 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. 9815 DATE 9-18-03 y MO. DAY YR. • REPAIRED BY FINAL TEST BY LATE 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 NOA NO.2 CLOSTIGHT CLOSED TIGHT OPENED AT LBS. 'ISLES. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL S7 # tbs. ! - # tbs. *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 ❑ OPENED AT_LEE OPENED AT TEST #LBS #LBS _LBS ALBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY� CERTIFIED TESTER NO. 9815 DATE 9-18-03 y MO. DAY YR. • REPAIRED BY FINAL TEST BY LATE 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 0 BACKFLOW PREVENTION SPECIALIST;- z LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 4844FLOSY$054 4 2003 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1358 (408) 269-2600 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269-2850 n<r. ID • SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT AnthOnY 3975 Freedom Cir., Ist floor TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Feboo 825YA RP 2" A021891 INTERNAL ❑ TAG LOCATION OF DEVICE irtigation mtr# 60112835 at Portal EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASSm FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE &sl�eINITIAL TEST BY, / CERTIFIED TESTER NO. 9815 • REPAIRED BY FINAL TEST BY 0.114 CERTIFIED TESTER NO. DATE 9-18-03 MO. DAY YR. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF N0.1 N0.2 VALVE AIR INLET CHECKVALVE ' CLOyED TIYT CLOSED TIGHT OPENED AT Z��B S. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL # Ib6. # Ibe. #LB3 0 LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1,10 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 OPENED AT _LBS OPENED AT _LBS tI.B3 THE ABOVE REPORT IS CERTIFIED TO BE TRUE &sl�eINITIAL TEST BY, / CERTIFIED TESTER NO. 9815 • REPAIRED BY FINAL TEST BY 0.114 CERTIFIED TESTER NO. DATE 9-18-03 MO. DAY YR. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS ,"`•r BACKFLOW PREVENTION VALVE EXPERT ' INSTALLATION -REPAIRS -TESTING -CERTIFICATION 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) 269-26W �+ 'f ftD 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269-2650 SEP 2 4 200 SERVICE ADDRESS 10200 S DO Acnes Blvd., C rtino/X-Stevens Creek I MAILING ADDRESS Tishman Swyer CONTACT A�Y-_ 3975 Freedom Cir., 1st floor TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975 RP 3" B22660 INTERNAL ❑ TAG LOCATION OF DEVICE main mtr# 60112842 at Portal EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSE FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY /�I�� CERTIFIED TESTER NO. 9815 DATE 9-18-03 REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR.. MO. DAY YR. m 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 CLOgV TIGHT CLOSED TIGHT //�� OPENEDAT� ` 13S. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL # Ibe. / • # Ib& #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 OPENED ATL&S _ OPENED AT _ #LBS #LBS tLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY /�I�� CERTIFIED TESTER NO. 9815 DATE 9-18-03 REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR.. MO. DAY YR. m