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BACKFLOW (14)CERTIFICATION OF RECLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS_,, BACKFLOW PREVENTION VALVE EXPERT INSTALLATI.ON-REPAIRS-TESTINGCERTIFICATION S �9se. 1-21-05 %ACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 464 -PLOW (3569) 3750-E CHARTER PARK DR., SAN JOSE CA 951361356 (408) 269.2600 3608 FERNWOOD ST., SAN MATEO CA 94403 FAX (408) 269-2650 ' • SERVICE ADDRESS 20400 Stevens Creek Blvd., Cupertino/X-De Anza Blvd MAILING ADDRESS Prometheus CONTACT Bob 20400 Stevens Creek Blvd TEL# 410-6517 Cupertino, CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE - SERIAL NUMBER Febco 825Y RP 11/2", H01480 INTERNAL ❑ TAG LOCATION OF DEVICE irrigation De Anza between Cypress Hotel garage and EXTERNAL Portal Bldg IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSIR FAILCI THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY REDUCED PRESSURE DEVICES 2656 DATE 1-21-05 PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS MO. DAY RPP VALVES DIFFERENTIAL CHECKVALVE CHECK VALVE PRESSURE I RELIEF VALVE AIR INLET CHECKVALVE NOA NO.2 CLOSE TIGHT CLOSED TIGHT OPENED AT _CJ LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL t lbs. � � # 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 NALCLOSED TIGHT❑ CLOSED TIGHT CLOSED TIGHTEST TI #LBS iLBS OPENED AT_LBS OPENED ATLBS ILBB THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY ..' CERTIFIED TESTER N0. 2656 DATE 1-21-05 FINAL TEST BY MO. DAY YR. DATE CERTIFIED TESTER NO. DATE MO. DAY YR. REPAIRED BY • FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS �,�iit.. CROSS CONNECTION TS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS ALVE EE XPERT BACKFLOW PREVENTIOONN VALVE INSTALLATION -REPAIRS -TESTING -CERTIFICATION Sfee44w �j0' QBACKFLOW 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 FAX (408) 288-2650 3608 FERNWOOD ST., SAN MATEO CA 94403 DIFFERENTIAL Is • SERVICE ADDRESS 20400 Stevens Creek MAILING ADDRESS Prometheus 20400 Stevens Creek Blvd Anza Blvd Cupertino, CA 95014 MANUFACTURER MODEL NUMBER TYPE Wilkins INTERNAL fiff-- EXTERNAL ❑ RP CONTACT Bob TEL# 410-6517 SIZE SERIAL NUMBER 2" W8709 TAG LOCATION OF DEVICE by pool entrance and gas meter on irrigation IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS4—FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 2656 DATE 1-21-05 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 I RELIEF VALVE AIR INLET CHECKVALVE NOA NO.2 CLOSED TIGHT CLOSED TIGHT OPENED AT_O LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL Ilbe. 0" 9Ibe. #LBS 41BS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED rTI:Z CLOSED TIGHT ❑ CLOSED TIGHT ElOPENEDAT_LBS CLOSED TIGHTST OPENEDAT_LBS #IBS ILBS IMIS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 2656 DATE 1-21-05 MO. DAY YR. REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMSSAS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS' �j BACKFLOW PREVENTION VALVE EXPERT INSTALLAT70N-REPAIRS-TESTINTING-CERTIFICATION ftACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 464 -FLOW (3569) 3750-E CHARTER PARK DR., SAN JOSE CA 95138-1356 (408) 269-2600 3608 FERNWOOD ST., SAN MATEO CA 84403 FAX (408) 269-2650 0 SERVICE ADDRESS 20400 Stevens Creek Blvd., Cupertino/X-De Anza Blvd MAILING ADDRESS Prometheus CONTACT Bob 20400 Stevens Creek Blvd TEL# 410-6517 Cupertino, CA 95014 MANUFACTURER MODEL' NUMBER TYPE SIZE SERIAL NUMBER Ames 2000 DCA 6" 0830019 INTERNAL ❑ TAG LOCATION OF DEVICE garage fire protection EXTERNAL IlyOL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY G CERTIFIED TESTER NO. 2656 DATE 1-21-05 MO. DAY YR. REPAIRED BY 9 _ 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 CHECK VALVE PRESSURE/RELIEF VALVE AIR INLET CHECK VALVE N0.1 N0.2 CLOSEDTIGHT,O CLOSEDTIGHT OPENEDAT_LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL # Ibs. —1.4 # Ibe. /� 9 *LBS # LBS. TEST OPENED UNDER 2.0 OPENED UNDER ID LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIR$ AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT C1TEST #LBS #LBS OPENED AT _LBS OPENED AT LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY G CERTIFIED TESTER NO. 2656 DATE 1-21-05 MO. DAY YR. REPAIRED BY 9 _ FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR.