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BACKFLOW PREVENTION CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS d 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)268-2800 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650 K'..l SERVICE ADDRESS 20807 Stevens Creek Blvd.,Cu ertino/X-Saich Wy. A1169 2 7nng MAILING ADDRESS Stevens Creek Retail Assoc. CONTACT Mel i - 20833 Stevens Creek Blvd.,#102 TEL# 252-7988 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 860 RP 2, H09026 INTERNAL ❑ TAG LOCATION OF DEVICE mtr#62024506 EXTERNAL IF DEVICE ISA NEW 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 N0.1 �( N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT (aj CLOSED TIGHT i16 OPENED AT�+o LBS. OPENED AT_LSS CLOSED TIGHT ❑ INITIAL i]be. 7. R Iba. *LBS 0 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 ❑ OPENED AT_LBS OPENED AT_LBS CLOSED TIGHT 13T EST #LBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST <:1Qz/ CERTIFIED TESTER NO. 10466 DATE 8-12-05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS $ " "�4'.�. CROSS CONNECTION SPECIALISTS S CERTIFIED CROSS CONNECTION CONTROL CONSULTANT ' BACKFLOW PREVENTION VALVE EXPERT �j INSTALLATION-REPAIRS-TESTINGLERTIFICATION • BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464 FIOW."(35Q69)ETV.ED 3750-E CHARTER PARK DR.,SAN JOSE CA 851361356 - (408)269.2600 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269.2650 AUG 2 2 2005 SERVICE ADDRESS 20807 Stevens Creek Blvd.,Cupertino/X-Saich Wy. ----_ MAILING ADDRESS Stevens Creek Retail Assoc. CONTACT Melanie 20833 Stevens Creek Blvd.,#102 TEL# 252-7988 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 825Y RP 2„ H12786 INTERNAL ❑ TAG LOCATION OF DEVICE EXTERNAL IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSd FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF NOA NO.2 VALVE AIR INLET CHECKVALVE CLOSED TIGHT I CLOSED TIGHT OPENED AT LBS. OPENED AT_LBS' CLOSED TIGHT ❑ INITIAL i Its. 7.8 t Ibs. #LBS #LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED Cl LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED Cl REPAIRS AND MATERIALS , USED FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ OPENED AT LBSOPENED AT_L8S CLOSED TIGHT TEST #LBS #LBS (LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE. INITIAL TEST BY CERTIFIED TESTER NO. 10466 DATE 8-12-05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS �__�..���//��... CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANT Sv ,: 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(408'2g69-26Fip-+T.e` .D SERVICE ADDRESS 20807 Stevens Creek Blvd.,Cu ertino/X-Saich W . AUG 2 2005 MAILING ADDRESS Stevens Creek Retail Assoc. CONTAf9Melanie 20833 Stevens Creek Blvd.,#102 TEL# 252-7988 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 860 RP 2° H09040 INTERNAL ❑ TAG LOCATION OF DEVICE mtT#62024504 EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX Cl PASSCJ FAIL❑ • REDUCED PRESSURE DEVICES ,\ PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF NOA NO.2 VALVE AIR INLET CHECKVALVE CLOS,pED'CLGHT CLOSED TIGHT OPENED AT'IV1 00 LBS. OPENED AT_-_LBS CLOSED TIGHT ❑ INITIAL O lbs. U• #Ibs. #LBS 0 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 ❑ OPENED AT_LBS OPENED AT_LBS CLOSED TIGHT❑ TEST #LOS OLBS ILBS THE ABOVE REPORT 18 CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10466 DATE 8-12-05 MO. DAY YR. •REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS fM " '4 CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS _,, INSTALLATION-REPAIRS-TESTING-CERTIFICATION BACKFLOW PREVENTION SPECIALIST�.�`` S�g+. J.N_q, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)r_1AUG LO11(3569)'VE 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)289-2600 2 2D05 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)260.2650 20807 Stevens Creek Blvd.,Cu ertino/X-Saich W � SERVICE ADDRESS P Y• 11 �' MAILING ADDRESS Stevens Creek Retail Assoc. CONTACT Melanie 20833 Stevens Creek Blvd.,#102 TEL# 252-7988 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 950XL 3/4" 2042593 INTERNAL ❑ TAG LOCATION OF DEVICE TOO 30032778 fire by pass 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 DIFFERENTAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF NO.1 NO.2 VALVE AIR INLET CHECKVALVE CLOSED TIGHT'W CLOSED TIGHT OPENED AT_LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL :Ibe.� C A Ibe. a -'4' OLBS 0 LBS. TEST OPENED UNDER 2.0 OPENED UNDER t.0 LEAKED Cl LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ OPENED AT LES OPENED AT_ CLOSED TIGHT TEST #LBS #LBS LBS /LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE CD INITIAL TEST BY / S / p�yL CERTIFIED TESTER NO. 10466 DATE 8-12-05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTSBACKFLOW PREVENTION VALVE EXPERT , �I INSTALLATION-REPAIRS-TESTING-CERTIFICATION • SAeaA'(lars 9se BACKFLOW PREVENTION SPECIALISTS 1 ; C, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)r484FLOW`3589) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136.1356 (408)289-2600 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408) 69-2650 F _ SERVICE ADDRESS 20807 Stevens Creek Blvd.,Cupertino/X-Saich Wy. MAILING ADDRESS Stevens Creek Retail Assoc. CONTACT Melanie 20833 Stevens Creek Blvd.,#102 TEL# 252-7988 Cupertino,CA 95014 MANUFACTURER MODELNUMBER TYPE SIZE SERIAL NUMBER Wilkins 450DA 6" P01384 INTERNAL ❑ TAG LOCATION OF DEVICE mtr#30032778 fire EXTERNAL IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSP FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF NOA NO.2 VALVE AIR INLET CHECKVALVE CLOSED TIGHT O CLOSED TIGHT OPENED AT_LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL {MS. 0Ibs. Ll.il #LBS 0 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_LBS OPENED AT_LBS ❑ TEST {LBS {LBS {LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BYCERTIFIED TESTER NO. 10466 DATE 8-12-05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR.