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BACKFLOW (10)CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS A� �j INSTALLATION -REPAIRS -TESTING -CERTIFICATION %ACKFLOW PREVENTION SPECIALI jN_C.._ LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) dW (`35�69I VE� 3750-E CHARTER PARK DR., SAN JOSE CA 95138.1356 (408) 269-2600 NOV 0 5 2003 3608 FERNWOOD ST., SAN MATEO CA 94403 FAX (408) 269-2850 • SERVICE ADDRESS 20400 Stevens Creek Blvd., Cupertino/X-De Anza Blvd MAILING ADDRESS PrOmetheuS 20400 Stevens Cteek Blvd. Cupertino, CA 95014 MANUFACTURER MODELNUMBER TYPE Febco 805Y DC INTERNAL ❑ TAG EXTERNAL ❑ CONTACT Matt Hart TEL# 679-2338 LOCATION OF DEVICE chiller make SIZE SERIAL NUMBER 2" R9871 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASSXFAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST, BY • REPAIRED BY FINAL TEST BY I ERTIFIED TESTER NO. 9815 DATE- ..._ ,.. - . MO. DAY YR: ;ERTIFIED TESTER NO. L-5 DATE MO. DAY YR. REDUCED PRESSURE DEVICES._ _ __PRESSURE TYPE ' DOUBLE CHECK VALVES' VACUUM BREAKERS'��, , RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF NO.1 NO.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT _ LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL #Ibs. Albs. #LBS ALBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 `� LEAKED )(.I LEAKED' OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS"` AND ✓I /Ja�1 MATERIALSUSED rFST EpT HT Tl01tT I nT � OPENEDAT�LBS OPENED A7_LBS CLOSED TIGHT Cl 0Las i� rr pBSOSEp _ETT tLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST, BY • REPAIRED BY FINAL TEST BY I ERTIFIED TESTER NO. 9815 DATE- ..._ ,.. - . MO. DAY YR: ;ERTIFIED TESTER NO. L-5 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 ,5`�4llets fib' %ACKFLOW PREVENTION SPECIALISTS, INC. • LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 3608 FERNWOOD ST.. SAN MATEO CA 94403 SERVICE ADDRESS MAILING ADDRESS 20400 Stevens Creek Blvd. Cupertino, CA 95014 MANUFACTURER MODEL NUMBER TYPE Watts 909 RP INTERNAL ❑ TAG EXTERNAL ❑ CALIFORNIA (800) 464 -FLOW (3589) (408) 269-2600 FAX (408) 269-265677F f-; �T CONTACT TEL# 679-2338 LOCATION OF DEVICE boiler make up NOV 0 5 2003 SIZE SERIAL NUMBER 1„ 423618 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PASSx FAIL❑ e REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECKVALVE CHECK VALVE PRESSURE/RELIEF VALVE AIR INLET CHECK VALVE N0.1 N0.2 CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT _ LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL # tbs. # Ib& #LBS # LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED LEAKED �J OR DID NOT OPEN El OR DID NOT OPEN ❑ LEAKED El REPAIRS -.ss t6pJGUPC/ V1000 AND 0QC �eC , MATERIALS ` USED FINAL CLOSE TI CLOSED CLOSED TIGHT �L CLOSED TIGHT ❑ TEST OLDS 7 / #LBS OPENED AT _" LBS OPENED AT _LBS LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE PAINITIALTEST BY/kj-';;t7l�4e CERTIFIED TESTER NO. 9815 DATE • REPAIRED BY 4�A DATE /�• `3 / O 10-31-03 MO. DAY YR. FINAL TEST SY CERTIFIED TESTER NO,_ DATE/0, /• O,� MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT �. ���� INSTALLATION -REPAIRS -TESTING -CERTIFICATION %ACKFLOW PREVENTION SPECIALISTS, INC. C I LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 3608 FERNWOOD ST.. SAN MATEO CA 94403 SERVICE ADDRESS 20400 Stevens Creek Blvd20400 Stevens Creek Blvd., Cu�rtino/X-De Anra Blvd -De ADra Blvd MAILING ADDRESS PromethCUS 20400 Stevens Creek Blvd. Cu�rtino, CA 95014CA 95014 MANUFACTURER MODEL NUMBER TYPE Feboo 805Y DC INTERNAL ❑ TAG EXTERNAL ❑ CALIFORNIA (800) 464 -FLOW (3569) (408) 269-2600 FAX(408)269-2650 CONTACT TEL# 679-2338 LOCATION OF DEVICE chiller make up SIZE SERIAL NUMBER V U1365 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASS ' FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE r INITIAL TEST BY ctOrIFIEDTESTERNO.9815 DATE 10-31-03 MO. DAY YR. t • REPAIRED BY DATE FINAL TEST BY ..� CERTIFIED TESTER NO. 4 DATE�� MO. DAY YR. 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 CLOSED TIGHT T OPENED AT _ LBS. OPENEDAT _ LBS CLOSED TIGHT ❑ INITIAL q Ibs. _- _ _ 0Ibs #LBS p LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED \p�,.f' LEAKED❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS e4lye #//O' 4 �r (� V p IC'L" �'1 AND MATERIALS /C C� CC �I T'Y '1 C USED ' O•- 1 Cr K CLOSED 7jIGFjT ❑ CLOSEj? TIC iTOPENEDA-C � -• =LBS OPENED AT LBS CLOSED TIGHT gLBS pLBS tF/) _ 9LB3 THE ABOVE REPORT IS CERTIFIED TO BE TRUE r INITIAL TEST BY ctOrIFIEDTESTERNO.9815 DATE 10-31-03 MO. DAY YR. t • REPAIRED BY DATE FINAL TEST BY ..� CERTIFIED TESTER NO. 4 DATE�� MO. DAY YR.