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BACKFLOWCERTIFICATION OF RE-CLAIMED WATER SYSTEMS �^0'"av CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS T '3" BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION CALIFORNIA (800) 464 -FLOW (3569)`�� • LOCAL (408) 269-2600 FAX (408) 269-2650 S . LICENSED CONTRACTOR C.C.L.0 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 MAILING / OWNER Cupertino City Center Bldgs Address 20400 Stevens Creek Blvd #230 Cupertino, CA. 95014 CONTACT: Bob Camarda MANUFACTURER MODELNUMBER Watts 909QT SERVICE Cupertino City Center Bldgs FEB j ADDRESS 20400 Stevens Creek Blvd. Cupertino, CA. 95014 C TEL# 408-410-6517 TYPE SIZE SERIAL NUMBER RP 1" 367077 NEW INSTALLATION: E] REPLACEMENT: REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE Boiler make up roof INTERNAL ® METER # EXTERNAL ❑ TAG # Hazar�101 IIw Comments: THE ABOVE REPORT IS CERTIFIED TO E TRUE •NITIAL TEST BY r CERTIFIED TESTER NO. 11277 DATE 01/31/08 II MO. DAY YR. REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. PASS FAIL PASS ❑ FAIL ❑ REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valvas DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE / RELIEF AIR INLET CHECK VALVE N0.1 N0.2 VALVE #1 #2 CLOSED TIG T :I# CLOSED TIGHT `���/ OPENED AT 31 0 LBS. OPENED AT LBS CLOSED TIGHT ❑ CLOSED TIGHT❑ INITIAL #Its. 7, lbs. OPENED UNDER 1,0 #LBS LEAKED ❑ ❑ TEST OPENED UNDER 2.0 R DID NOT OPEN ❑ LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT❑ OPENED AT _#LBS PENED AT #LB CLOSED TIGHT ❑ ❑ TEST MLBS #LBS MLBS Comments: THE ABOVE REPORT IS CERTIFIED TO E TRUE •NITIAL TEST BY r CERTIFIED TESTER NO. 11277 DATE 01/31/08 II MO. DAY YR. REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. PASS FAIL PASS ❑ FAIL ❑ CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS • CALIFORNIA (800) 464 -FLOW (3569) LOCAL (408) 269-2600 FAX (408) 269-2650 CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIA MAILING /OWNER Cupertino City Center Bldgs SERVICE Cupertino City Cent' Id Address ADDRESS 20400 Sevens Cree B vd. 20400 Stevens Creek Blvd #230 Cupertino, CA. 95014 Cupertino, CA. 95018y- CONTACT: 50 y_ CONTACT: Bob Camarda TEL# 408-410-6517 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins NEW INSTALLATION: ❑ 575 REPLACEMENT: ❑ lai 9 W8709 REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE by pool entrance and gas meter on irrigation INTERNAL ❑ EXTERNAL® METER # TAG # Hazard T fie: r Comments: THE ABOVE REPORT IS CERTIFIED TORE TRUE f •INITIAL TEST BY REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO. 11277 DATE CERTIFIED TESTER NO. DATE 01/31/08 MO. DAY YR. PASS❑ DATE FAIL ❑ MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE Shuloff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE AIR INLET CHECK VALVE PRESSURE/RELIEF NOA NO.2 VALVE F#1-1#-2 CLOSED TIG T CLOSED TIGHT OPENED AT2_L_� LBS. OPENED AT LES CLOSED TIGHT ❑ CLOSEDTIGHT❑ 79 INITIAL # lbs. # Ibs. OPENED UNDER 1.0 # LBS. LEAKED ❑ ❑ TEST OPENED UNDER 2.0 R DID NOT OPEN ❑ LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT❑ OPENED AT_#LBS PENED AT XLB CLOSED TIGHT❑❑ TEST #LBS #LBS ALBS Comments: THE ABOVE REPORT IS CERTIFIED TORE TRUE f •INITIAL TEST BY REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO. 11277 DATE CERTIFIED TESTER NO. DATE 01/31/08 MO. DAY YR. PASS❑ DATE FAIL ❑ MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS ♦ Y CI CALIFORNIA (800) 464 -FLOW (3569)'=1� CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION LOCAL (408) 269-2600 ,5 -7,6. LICENSED CONTRACTOR C.C.L.# 427328 FAX (408) 269-2650 3750-E CHA R PARK DR., SAN JOSE CA 95136-1356 CKFLOW PREVENTION SPECI P 8ft-Oft. FEB MAILING/ OWNER Cupertino CityCenter Bldgs SERVICE Cupertino ino Ci[ ter Bld s 19 2008 Address ADDRESS 20400 Stevens Creek Blvd #230 20400 Stevens trqek Blvd. Cupertino, CA. 95014 Cupertino, CA. CONTACT: Bob Camarda TEL# 408-410-6517 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 825Y RP 1 1/2" HO 1480 NEW INSTALLATION: ❑ REPLACEMENT: ❑ MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE Irrigation De Anza between Cypress Hotel garage and portal INTERNAL ❑ . METER # EXTERNAL ® TAG # Ha and T e: ) Comments: THE ABOVE REPORT IS CERTIFIED TUE —INITIAL TEST BY J ' CERTIFIED TESTER N0, 11277 DATE 01/31/08 MO. DAV YR. REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO DATE MO. DAY YR. PASS FAIL PASS ❑ FAIL ❑ REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE AIR INLET CHECK VALVE PRESSURE / RELIEF N0.1 N0.2 VALVE #1 #2 CLOSED TIGHT CLOSED TIGHT OPENED AT BE. OPENED AT LBS CLOSED TIGHT ❑ CLOSED TIGHT❑ INITIAL p lbs.'�T # Ibs. LEAKED ❑ ❑ OPENED UNDER 1.0 q LBS. TEST OPENED UNDER 2.0 R DID NOT OPEN ❑ LEAKED ❑ LEAKED Cl OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ TIGHT❑ OPENED AT_#LBS JCLOSED PENEO AT_gLB CLOSED TIGHT❑❑ TEST NLBS gLBS pL85 Comments: THE ABOVE REPORT IS CERTIFIED TUE —INITIAL TEST BY J ' CERTIFIED TESTER N0, 11277 DATE 01/31/08 MO. DAV YR. REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO DATE MO. DAY YR. PASS FAIL PASS ❑ FAIL ❑ CERTIFICATION OF RE-CLAIMED WATER SYSTEMS g�d6�°0°' CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS -,A BACKFLOW PREVENTION VALVE EXPERT • INSTALLATION -REPAIRS -TESTING -CERTIFICATION CALIFORNIA (800) 464 -FLOW (3569) LOCAL (408) 269.2600 $ ���. LICENSED CONTRACTOR C.C.L.# 427328 FAX (408) 269-2650 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIALISTS, INC. MAILING/OWNER Cupertino City Center Bldgs' SERVICE Cupertino Cit NIX Art L/ Address ADDRESS 20400 Stevens Creek Blvd #230 20400 Stevens ek }v . Cupertino, CA. 95014 CONTACT: Bob Camarda MANUFACTURER MODELNUMBER Ames 2000 TEL# 408-410-6517 TYPE SIZE SERIAL NUME DCA 6" 0830019 NEW INSTALLATION: ❑ REPLACEMENT: U REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE garage fire protection INTERNAL ❑ METER # EXTERNAL ® TAG # Hazard Type, \ "LL � Comments: •THE ABOVE REPORT IS CERTIFIED TO BE TRUE -v INITIAL TEST ByIiL� CERTIFIED TESTER NO. 11277 REPAIRED BY _ DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 0 1/3 1/08 MO. DAY YR. DATE MO. DAY YR. MPASS FAIL ❑ PASS ❑ FAIL ❑ REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE AIR INLET CHECK VALVE PRESSURE/RELIEF NO.1 NO.2 VALVE #1 FT CLOSED TIGHT CLOSED11GHTTgr, OPENED AT_ LBS. OPENED AT—LBS CLOSED TIGHT❑ CLOSED TIGHT INITIAL q lbs. ZJL� # Iles. 1 LEAKED ❑ ❑ UNDER I.O # LBS. TEST OPENED UNDER 2.0 R DID N T R IO NOT OPEN ❑ LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS P AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ yr "� CLOSED TIGHT❑ OPENED AT ALBS OPENED tlL9 CLOSED TIGHT❑❑ TEST gLBS gLBS IAT gLBS Comments: •THE ABOVE REPORT IS CERTIFIED TO BE TRUE -v INITIAL TEST ByIiL� CERTIFIED TESTER NO. 11277 REPAIRED BY _ DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 0 1/3 1/08 MO. DAY YR. DATE MO. DAY YR. MPASS FAIL ❑ PASS ❑ FAIL ❑ CERTIFICATION OF RE-CLAIMED WATER SYSTEMS pO°' CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS '1' , 3" BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION CALIFORNIA (800) 464 -FLOW (3569) • LOCAL (408) 269-2600 S , LICENSED CONTRACTOR C.C.L.# 427328 FAX (408) 269-2650 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIALISTS, INC. MAILING/ OWNER Cupertino City Center Bldgs Address 20400 Stevens Creek Blvd #230 Cupertino, CA. 95014 CONTACT: Bob Camarda MANUFACTURER Febco NEW INSTALLATION: MODEL NUMBER 805Y REPLACEMENT: REPLACEMENT DEVICE INFORMATION MANUFACTURER MODELNUMBER INTERNAL ® METER# EXTERNAL ❑ TAG # Hazard Tvoe: CoQ 10 0 vv • SERVICE Cupertino City Center BI D L/ ADDRESS 20400 Stevens Creek Blvd. Cupertino, CA. 95014 TEL# 408-410-6517 BV TYPE SIZE SERIAL NUMBER DC 2" A041780 TYPE SIZE SERIAL NUMBER LOCATION OF DEVICEchiller make up / heat exchanger roof THE ABOVE REPORT IS CERTIFIED TO BE TRUE ,r NITIAL TEST BY 1 REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO. 11277 DATE CERTIFIED TESTER NO, PASS ❑ DATE 01/31/08 FAIL MO. DAY YR. PASS❑ DATE FAIL ❑ MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS DIFFERENTIAL CHECK VALVE CHECK VALVE AIR INLET ' CHECK VALVE PRESSURE / RELIEF NO.1 N0.2 VALVE #1 12 CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT_ LBS. OPENED AT —LES CLOSED TIGHT El CLOSED TIGHT INITIAL # lbs. #Iles. #LBS. LEAKED 13 13 TEST OPENED UNDER 2.0 OPENED UNDER 1.0 R DID NOT OPEN ❑ LEAKED ❑ LEAKED OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT_#LBS PENED AT_#LB CLOSED TIGHT ❑ ❑ TEST gLBS ALBS MLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE ,r NITIAL TEST BY 1 REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO. 11277 DATE CERTIFIED TESTER NO, PASS ❑ DATE 01/31/08 FAIL MO. DAY YR. PASS❑ DATE FAIL ❑ MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS fu6�°°" CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'T" , '3' BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION • CALIFORNIA (800) 464 -FLOW (3569) LOCAL (408) 269-2600Sfieerlraas LICENSED CONTRACTOR C.C.L.# 427328 FAX (408) 269-2650 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 BACKFLOW PREVENTION SPECIALISTS INC. MAILING /OWNER Cupertino City gs Center BldSERVICE Cupertino Ci[ Center Bldgs D v u D Address ADDRESS 20400 Stevens Creek Blvd. 20400 Stevens Creek Blvd #230 Cupertino, CA. 95014 Cupertino, CA. 95014 CONTACT: Bob Camarda MANUFACTURER Febco NEW INSTALLATION: ❑ MODELNUMBER 805Y REPLACEMENT: TEL# 408-410-6517 TYPE SIZE SERIAL NUMBER DC V, U1365 REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICEchiller make up roof, Bldg. #20400 INTERNAL ® METER# EXTERNAL ❑ 1 TAG # 7 Comments: C ova CAAi V- REDUCED PRESSURE DEVICES voAre r r t, V _a L d PRESSURE TYPE THE ABOVE REPORT IS CE TINED TO B',7 UE Shutoff Valves DOUBLE CHECK VALVES • YCERTIFIED VACUUM BREAKERS INITIAL TEST BY TESTER NO. 11277 DIFFERENTIAL FASS ❑ CHECK VALVE CHECK VALVE AIR INLET REPAIRED BY DATE PRESSURE/RELIEF N0.1 N0.2 VALVE FINAL TEST BY CHECK VALVE DATE FAIL ❑ MO. DAY YR. #1 1#2 CLOSED TIGHT ® CLOSED TIGHT L`1 OPENED AT _ LBS. OPENED AT LES CLOSED TIGHT ❑ CLOSED TIGH If lbs. # lbs. ' I /+ LEAKED INITIAL OPENED UNDER 1.0 #LBS. ❑ ❑ TEST OPENED UNDER 2.0 OR DID NOT OPEN ❑ LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT El OPENED AT_RLBS PENED AT dL6 CLOSED TIGHT❑❑ TEST #LBS #LBS p LBS 7 Comments: C ova CAAi V- tM vA No voAre r r t, V _a L d a v\- f2 tom. THE ABOVE REPORT IS CE TINED TO B',7 UE • YCERTIFIED INITIAL TEST BY TESTER NO. 11277 DATE 01/31/08 FASS ❑ MO. DAY YR. REPAIRED BY DATE PASS ❑ FINAL TEST BY CERTIFIED TESTER NO. DATE FAIL ❑ MO. DAY YR.