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NO PERMIT NUMBER (6) CERTIFICATION OF RE-CLAIMED WATER SYSTEMS _�A •x. _ CROSS CONNECTION SPECIALISTS
�
�, BACKFLOW PREVENTION VALVE EXPERT
CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS ���' INSTALLATION-REPAIRS-TESTING-CERTIFICATION
�x sher.(uu�9se
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)269-2650
SERVICE ADDRESS 19500 Pruneridge Ave.,Cupertino/X-Wolfe
MAILING ADDRESS The Hamptons CONTACT Edgarl Nov 0 .9 2005
I,
19500 Pruneridge Ave. TEL# 408-873-88T00Y1s__
Cupertino,CA 95014
MANUFACTURER MODELNUMBER TYPE SIZE SERIAL NUMBER
Wilkins 975XL RP- 1 1/2" 532158
INTERNAL ❑ TAG LOCATION OF DEVICE prop line 40' from curb carport 21 irrigation
EXTERNAL ® in enclosure
IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PAS FAIL❑
• REDUCED PRESSURE DEVICES
PRESSURE TYPE,I
' ECHECPP VES - 'Fj:.l .... ., �.. BREAKERS
--.
._
DOUBLE CHECK VALVES.... _- VACUUM BRE
DIFFERENTIAL
CHECK VALVE CHECK VALVE PRESSURE/RELIEF
NOA NO.2 VALVE AIR INLET CHECK VALVE
CLOSED TIGHTCLOSED TIGHT 4
OPENED AT 12 LBS. OPENED AT_LBS CLOSED TIGHT ❑
INITIAL f Ibi7� p 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 ❑ OPENEDAT_LBS OPENED AT_LBS CLOSED TIGHT❑
TEST #LBS #LBS #LBS
THE ABOVE REPORT IS CERTIFIED TO BE TRUE
CERTIFI
INITIAL TEST BYZzd&l//WED TESTER N0. 10866 DATE,_11`04-05
,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 CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT
1- INSTALLATION-REPAIRS-TESTING-CERTIFICATION
�ID
BACKFLOW PREVENTION SPECIAL�ISrTS1. .
LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569)- ---
3750.E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-260 --
3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650
SERVICE ADDRESS 19500 Pruneridge Ave.,Cupertino/X-Wolfe
MAILING ADDRESS The Hamptons CONTACT Edgar
19500 Pruneridge Ave. TEL# 873-8800
Cupertino,CA 95014
MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER
Wilkins 975 RP 1 1/2° 595894
INTERNAL ❑ TAG LOCATION OF DEVICE next to carport 146 irrigation in enclosure
EXTERNAL
IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX[] PAS$ft FAIL❑
REDUCED PRESSURE DEVICES
PRESSURE TYPE
DOUBLE CHECK VALVES VACUUM BREAKERS
RPP VALVES DIFFERENTIAL
CHECK VALVE CHECK VALVE PRESSURE/RELIEF
N0.1 N0.2
VALVE AIR INLET CHECK VALVE
CLOSDTIGHT CLOSED TIGHT Ig OPENED AT LBS. OPENED AT_LOS 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❑
OPENED AT_LBS OPENED AT_LBS
TEST *LBS YLBS sUBS
THE ABOVE REPORT IS CERTIFIED TO BE TRUE
INITIAL TEST BY / " 'A` ) w"l�r CERTIFIED TESTER NO. 10866 DATE 11-04-05
MO. DAY YR.
0, REPAIRED BY DATE
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 ,
y INSTALLATION-REPAIRS-TESTING-CERTIFICATION
• ^Sfat�(��9�•
BACKFLOW PREVENTION SPECIALISTS, INC.
--
LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464 FLOW Z35-6 )
3750-E
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3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 v,°�`- I
3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650 NIn V 2005
SERVICE ADDRESS 19500 Pruneridge Ave.,Cupertino/X-Wolfe
MAILING ADDRESS The Hamptons CONTACT Edgar
19500 Pruneridge Ave. TEL# 873-8800
Cupertino,CA 95014
MANUFACTURER MODELNUMBER TYPE SIZE SERIAL NUMBER
Wilkins 975 RP 11/2" 595500
INTERNAL ❑ TAG LOCATION OF DEVICE left of basketball court irrigation in enclosure
EXTERNAL
IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[j PAS FAIL❑
• REDUCED PRESSURE DEVICES
PRESSURE TYPE
DOUBLE CHECK VALVES VACUUM BREAKERS
RPP VALVES DIFFERENTIAL
CHECK VALVE CHECK VALVE PRESSURE I RELIEF
NOA �A NO.2 VALVE AIR INLET CHECK VALVE
CLOSED TIGHT CLOSED TIGHT OPENED AT - ._LBS. OPENED AT_LBS CLOSED TIGHT ❑
INITIAL #IN.
Q
6/ #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 OPENED AT_LBS OPENED AT_LBS #LBS
THE ABOVE REPORT IS CERTIFIED TO BE TRUE/
INITIAL TEST BY V , �I�'�^ CERTIFIED TESTER NO. 10866 DATE 11-04-05
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
IFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT
CERT
) ., 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 7--�� Trq7-� 1�-�
3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650 JC` ECFil !/ Xil�
SERVICE ADDRESS 19500 Pruneridge Ave.,Cu ertino/X-Wolfe NOV © N 2885
MAILING ADDRESS The Hamptons CONTACT Edgar BY:---
.- __ 1
19500
Y:---- -
19500 Pruneridge Ave. TEL# 873-8800
Cupertino,CA 95014
MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER
Wilkins 975XL RP 11/2° 652499
INTERNAL ❑ TAG LOCATION OF DEVICE right of carpor 111 irrigation in enclosure
EXTERNAL
IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASS FAIL❑
REDUCED PRESSURE DEVICES VVV
�- PRESSURE TYPE
DOUBLE CHECK VALVES VACUUM BREAKERS
RPP VALVES DIFFERENTIAL
CHECK VALVE CHECK VALVE PRESSURE/RELIEF
N0.1 N0.2
VALVE AIR INLET CHECK VALVE
CLOSED TIGHT CLOSED TIGHT OPENED AT-I1 LBS. OPENEDAT_LBS CLOSEDTIGHT ❑
INITIAL •Ibs. `0 . sR' 0lbs. #LBS 9 LBS.
TEST —'•TT 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
� ALBS OLBS *LBS
THE ABOVE REPORT IS CERTIFIED TO BE TRUE
INITIAL TEST BY CERTIFIED TESTER NO. 10866 DATE 11-04-05
MO. DAY YR.
REPAIRED BY DATE
1
FINAL TEST BY CERTIFIED TESTER NO. DATE
MO. DAY YR.