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BACKFLOW (11)CERTIFICATION OF RE-CLAIMED WATER SYSTEMS /�"�4'y. CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS �•j ' BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS TESTING -CERTIFICATION BACKFLOW PREVENTION SPECIAUIST81-A.M. • 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 Blvd., Cupertino/X-De Anza Blvd MAILING ADDRESS Prometheus 20400 Stevens Creek Blvd., #245 Cupertino, CA 95014 MANUFACTURER MODEL NUMBER TYPE Watts INTERNAL ® TAG EXTERNAL ❑ 909QT RP CALIFORNIA ( (408) 269.2600 FAX (408) 269 - CONTACT Bob TEL# 410-6517 SIZE V LOCATION OF DEVICE boiler make up Roof IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS FAIL❑ SERIAL NUMBER 367077 THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO: -16"— 10866 DATE 1-9-06 •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 N0.1 N0.2 CLOSED TIGHT CLOSED TIGHT ,l OPENEDATJ 1 V LBS. OPENED AT_ LBS CLOSED TIGHT ❑ INITIAL Sibs. (0.4t— K lbs. *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 LES OPENED AT LES TEST ALBS /LBS iLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO: -16"— 10866 DATE 1-9-06 •MO. DAY YR. REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS�'M CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS_, BACKFLOW PREVENTION VALVE EXPERT �� INSTALLATION -REPAIRS -TESTING -CERTIFICATION 0 '�'.�" BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.# JOSE CALIFORNIA (800) 4.F �� 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 FAX 269-26009- � ��i I' 3608 FERNWOOD ST.. SAN MATED CA 94403 FAX (408) 269-265 • SERVICE ADDRESS 20400 Stevens Creek Blvd., Cupertino/X-De An2a Blvd MAILING ADDRESS Prometheus CONTACT Bob 20400 Stevens Creek Blvd TEL# 410.6517 Cupertino, CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC 2" A041780 INTERNAL ® TAG LOCATION OF DEVICE chiller make up/ heat exchanger Roof EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASSE FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY ! CERTIFIED TESTER NO. 10866 REPAIRED BY FINAL TEST BY Iml CERTIFIED TESTER NO. DATE 1-9-06 MO. DAY YR. 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 CHECKVALVE N0.1 N0.2 CLOSED TIGHT CLOSED TIGHT , OPENEDAT_LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL 0lbs. L' 0lbs. 1.6 *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 Cl CLOSED TIGHT ❑ CLOSED TIGHT ❑ TESTOPENED AT _ LBS OPENED AT LBS _ /LBS iLBS t LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY ! CERTIFIED TESTER NO. 10866 REPAIRED BY FINAL TEST BY Iml CERTIFIED TESTER NO. DATE 1-9-06 MO. DAY YR. DATE MO. DAY YR. CROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS 4i�"-'� '• --�4 BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 4..'u.- �' ,'' INSTALLATION -REPAIRS -TESTING -CERTIFICATION BACKFLOW PREVENTION SPECIA (� N LICENSED CONTRACTOR C.C.L.# 427328 - CALIFORNIA (800) --iSVV'( 69 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 (408) 269-2600 JAN 1 3608 FERNWOOD ST.. SAN MATEO CA 94403 FAX (408) 269-265 3 2 O0 6 • SERVICE ADDRESS 20400 Stevens Creek Blvd., Cupertino/X-De Anza Blvd MAILING ADDRESS Prometheus CONTACT Bob 20400 Stevens Creek Blvd., 9245 TEL# 410-6517 Cupertino, CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC 1° U1365 INTERNAL EXTERNAL ❑ TAG LOCATION OF DEVICE chiller make up Roof IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PAS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10866 • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 1-09-06 MO. DAY YR. DATE MO. DAY YR. REDUCED PRESSURq DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE • PRESSURE/RELIEF VALVE AIR INLET CHECK VALVE N0.1 N0.2 CLOSED TIGHT,6 CLOSED TIGHT OPENED AT _ LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL # Ibs. 3 # lbs. Z - G #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 A7 _LBS OPENED AT LBS TEST LBS - #LBS _ #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10866 • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 1-09-06 MO. DAY YR. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS '6�� Ayyt CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 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) 269-2650 is SERVICE ADDRESS MAILING ADDRESS Prometheus 20400 Stevens Creek Blvd Cupertino, CA 95014 MANUFACTURER MODELNUMBER TYPE Wilkins 575 Rp CONTACT Bob TEL# 410-6517 SIZE SERIAL NUMBER 2„ W8709 INTERNAL ❑ TAG LOCATION OF DEVICE by pool entrance and gas meter on irrigation c EXTERNAL ��`✓®Z' tel._ yyt.-�Zic.L C_dG IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX[] PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10866 • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 1-09-06 MO. DAY YR, 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 CLOSED TIGHT CLOSED TIGHT OPENED AT z_ZLBS. OPENED AT_LEIS CLOSEDTIGHT ❑ INITIAL 0lbs.y 0lbs. #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 ❑ AT LB S OPENED AT LBS TESTOPENED 1LBS tLBS _ _ ILBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10866 • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 1-09-06 MO. DAY YR, DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS Sem CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS_,' �r 1 INSTALLATION -REPAIRS -TESTING -CERTIFICATION BACKFLOW 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 20400 Stevens Creek MAILING ADDRESS Prometheus Anza 20400 Stevens Creek Blvd Cupertino, CA 95014 MANUFACTURER MODELNUMBER TYPE Febco 825Y RP CALIFORNIA (800) 464 -FLOW (3569) (408) 269-2600 FAX (408) 269-2650. R) T Jam. JAN 1 3 2006 CONTACT Bob TEL# 410-6517 SIZE SERIAL NUMBER 11/2" H01480 INTERNAL ❑ TAG LOCATION OF DEVICE irrigation De Anza between Cypress Hotel garage and EXTERNAL Portal Bldg IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASS) FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE ii4tINITIAL TEST BV CERTIFIED TESTER NO. 10866 DATE 1-9-06 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 CHECKVALVE CHECKVALVE PRESSURE/RELIEF VALVE AIR INLET CHECKVALVE NO.1 NO.2 CLOSED TIGHT CLOSED TIGHT OPENED AT3.2LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL f lbs. • lbs. #LBS # LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED Cl REPAIRS AND MATERIALS " USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT OPENED AT TEST>f LBS tLBS _LBS _LBS iLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE ii4tINITIAL TEST BV CERTIFIED TESTER NO. 10866 DATE 1-9-06 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE 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 NG -CERTIFICATION 3teey���9/a BACKFLOW 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 20400 Stevens Creek MAILING ADDRESS Prometheus 20400 Stevens Creek Blvd Anza Blvd Cupertino, CA 95014 MANUFACTURER MODEL NUMBER - TYPE Ames INTERNAL ❑ TAG EXTERNAL X 2000 DCA CALIFORNIA (800) (408) 269.2600 FAX (408) 269-2650 CONTACT Bob TEL# 410-6517 SIZE SERIAL NUMBER 6° 0830019 LOCATION OF DEVICE garage fire protection IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PAS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY LZ414 CERTIFIED TESTER NO. 10866 DATE 1-9-06 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 NOA NO.2 CLOSED TIGHT ❑ CLOSED TIGHT 'M OPENEDAT_LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL t Ibs. 1 - L' # Ibs. Z .' Z 7� #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 OPENED AT LBS TEST tLBS tlB$ _LBS 9UIS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY LZ414 CERTIFIED TESTER NO. 10866 DATE 1-9-06 MO. DAY YR. ' REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE. MO. DAY YR.