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BACKFLOW (3)CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ,6Oe' CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'F' .,� 'i' BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -R EPA I RS -TESTI NG -CERTIFICATION CALIFORNIA (800) 464 -FLOW (3569)`�� LOCAL (408) 269-2600 g� ��. LICENSED CONTRACTOR C.C.L.# 427328 %FAX (408) 269-2650 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 ACKFLOW PREVENTION SPECIALISTS, INC. MAILING / OWNER Cupertino City Center Bldgs Address 20400 Stevens Creek Blvd #230 Cupertino. CA. 95014 CONTACT: Bob Camarda MANUFACTURER Watts NEW INSTALLATION: MANUFACTURER INTERNAL ® METER EXTERNAL ❑ TAG # Hazard Type: • MODELNUMBER 9O9QT MODEL NUMBER ADDRESS 5. " ZO07 TYPE RP TYPE ino City Center Stevens Creek I ino, CA. 95014 517 SIZE LOCATION OF DEVICE Boder make up roof SIZE SERIAL NUMBER 367077 SERIAL NUMBER Comments: THE ABOVE RpPQ RUE �ITIAL TEST B CERTIFIED TESTER N0. 10866 REPAIRED BY DATE FINAL TEST BY DATE 02-07-07 MO. DAY YR. 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 q1 »2 CLOSED TIGHT �. CLOSED TIGHT OPENED ATZ�Q LBS. OPENED AT_LBS CLOSED TIGHT C1 CLOSED TIGHT Q INITIAL a lbs. 6 - a q lbs. LEAKED ❑ ❑ OPENED UNDER 1.0 *LBS. 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 ATgLBS PENED AT CLOSED TIGHT❑❑ TEST gLBS ALBS _ gLBS Comments: THE ABOVE RpPQ RUE �ITIAL TEST B CERTIFIED TESTER N0. 10866 REPAIRED BY DATE FINAL TEST BY DATE 02-07-07 MO. DAY YR. CERTIFIED TESTER NO. DATE MO. DAY YR. PASS FAIL ❑ PASS ❑ FAIL ❑ CERTIFICATION OF RE-CLAIMED WATER SYSTEMS,6�t6�°10'"wsgyt CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'I' , 'i' BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION CALIFORNIA (800) 464 -FLOW (3569)'�� LOCAL (408) 269-2600 S 9s°. 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 CA. 95014 CONTACT: Bob Camarda Cupertino City Center Bldgs 20400 Stevens Creek Blvd. L#'408-410-6517 CA. 95014 MANUFACTURER MODELNUMBER TYPE SIZE SERIAL NUMBER Febco 805Y DC 2" A041780 NEW INSTALLATION: ❑ REPLACEMENT: U REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICEchiller make up / heat exchanger roof INTERNAL ® METER # EXTERNAL ❑ TAG # Hazard Type: Comments: THE ABOVE REPORT 1111 00 0 B ONITIAL TEST BY RTIFIED TESTER N0. 10866 /REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO PASS DATE 02-07-07 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 NOA NO.2 VALVE #1 #2 �#Iyy CLOSED�Tt[r CLOSED TIGGHT �, OPENED AT LBS. OPENED AT—LBS CLOSED TIGHT❑ CLOSED TIGH TD INITIAL QIGHT # Ibs. � • A5 ED # lbs. . LEAKED ❑ ❑ 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 ❑ OPENED AT_#LBS OPENED AT_ CLOSED TIGHT❑❑ TEST ALBS ALBS ALBS Comments: THE ABOVE REPORT 1111 00 0 B ONITIAL TEST BY RTIFIED TESTER N0. 10866 /REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO PASS DATE 02-07-07 FAIL ❑ MO. DAY YR. PASS ❑ DATE FAIL ❑ MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ,�°�° CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 'i' ♦ Y' BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -R EPA I RS -TESTI NG -CERTIFICATION CALIFORNIA (800) 464 -FLOW (3569)•�� LOCAL (408) 269-2600 Sp, �qwa. LICENSED CONTRACTOR C.C.L.# 427328 10 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 Sevens Creek Blvd #230 Cupertino, CA. 95014 CONTACT: Bob Camarda MANUFACTURER Febco NEW INSTALLATION: MANUFACTURER INTERNAL ® METER EXTERNAL ❑ TAG # Hazard Type: • SERVICE Cupertino City Center Bldgs 4DORE§S 20400 Stevens Creek Blvd. Cupertino, CA. 95014 TEL# 408-410-6517 MODEL NUMBER TYPE SIZE SERIAL NUMBER 805Y DC 1" U1365 REPLACEMENT: ❑ MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICEchiller make up roof y U Comments: THE ABOVE REPORT ^�RFIEB - ITIAL TEST BYTIFIED TESTER NO. 10866 c. i REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 02-07-07 MO. DAY YR. 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 • NOA NO.2 VALVE F#7T#T CLOSED TIGHT CLOSED TIGHT lL/J' OPENED AT _ LBS. OPENED AT—LBS CLOSED TIGHT ❑ CLOSED TIG INITIAL Nibs. •% # Ibs. Z• A LEAKED ❑ ❑ OPENED UNDER 1.0 # LBS. 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 OPENED PENEO A7_#LB CLOSED TIGHT ❑❑ TEST #LBS #LBS - �#LBS # LB$ Comments: THE ABOVE REPORT ^�RFIEB - ITIAL TEST BYTIFIED TESTER NO. 10866 c. i REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 02-07-07 MO. DAY YR. 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 BACKFLOW PF CROSS SPECIALISTS BACKFLOW PREVENTION EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION LICENSED CONTRACTOR C.C.L.4 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 NTI-ON SPECIALISTS, INC. MAILING / OWNER Cupertino City Center Bldgs ' `F 13 Address 20400 Stevens Creek Blvd #230 Cupertino, CA. 95014 CONTACT: Bob Camarda MANUFACTURER MODEL NUMBER Wilkins 575 JEW INSTALLATION: REPLACEMENT: REPLACEMENT DEVICE INFORMATION MANUFACTURER MODEL NUMBER INTERNAL ❑ METER EXTERNAL® TAG .# Hazard Type: • SERVICE Cupertino City Center Bldgs ;ADDRESS 20400 Stevens.Creek Blvd. -- Cupertino, CA. 95014 TEL# 408-410-6517 TYPE SIZE SERIAL NUMBER RP 2" W8709 TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE by pool entrance and gas meter on irrigation Comments: THE ABOVE REP!��CEFTIFIED WITIAL TEST BY TESTER NO. 10866 REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 02-07-07 MO. DAY YR. DATE MO. DAY YR. PASS Rd 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 rrrhhh CLOSED TIGHT CLOSED TIGHT , / OPENED AT � G LBS. OPENED AT LBS CLOSED TIGHT ❑ CLOSED TIGHT21.4 INITIAL q lbs. � •�i q lbs. LEAKED ❑ ❑ OPENED UNDER 1.0 *LBS. 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 NUBS PENEO AT_01- CLOSED TIGHT C1❑ TEST gLBS gLBS _ gLBS Comments: THE ABOVE REP!��CEFTIFIED WITIAL TEST BY TESTER NO. 10866 REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 02-07-07 MO. DAY YR. DATE MO. DAY YR. PASS Rd FAIL ❑ PASS ❑ FAIL ❑ CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ,6F"r#' CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS.,, BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION CALIFORNIA (800) 464 -FLOW (3569) . LOCAL (408) 269-2600 S ��y. 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 Address ity Center Bldgs.r ens Creek Blvd 0230F�� CA. 95014 CONTACT: Bob Camarda MANUFACTURER Febco NEW INSTALLATION: MANUFACTURER INTERNAL ❑ METER # EXTERNAL ® TAG # Hazard Type: • 3ERVICE Cupertino Citv Center Bides (ADDRESS 20400 Stevens Creek Blvd. 7 Cupertino, CA. 95014 TEL# 408-410-6517 MODEL NUMBER TYPE SIZE SERIAL NUMBER 825Y RP 1 1/2" H01480 REPLACEMENT: ❑ VACUUM BREAKERS MODEL NUMBER TYPE SIZE SERIAL NUMBER LOCATION OF DEVICE Irrigation De Anza between Cypress Hotel garage and portal Bldg Comments: THE ABOVE REPORT IS CERTIFIED TO BE TRUE -� PASS G / CERTIFIED TESTER N0. 10866 DATE 02-07-07 FAIL ❑ •NITIAL TEST BV ��- MO. DAY YR. REPAIRED BY DATE FINAL TEST BY I CERTIFIED TESTER NO. DATE MO. DAY YR. 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 Cl OPENED AT7 . C/ LBS. OPENED AT LEE CLOSED TIGHT ❑ CLOSED TIGHT INITIAL # lbs. 2. % # lbs. LEAKED ❑ ❑ - OPENED UNDER 1.0 # LBS. TEST OPENED UNDER 2.0 R DID NOT OPEN Cl • LEAKED Cl LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑CLOSED TIGHT❑ OPENED AT PENEO AT_#LB CLOSED TIGHT ❑� TEST ALBS gLBS _ALBS ALBS Comments: THE ABOVE REPORT IS CERTIFIED TO BE TRUE -� PASS G / CERTIFIED TESTER N0. 10866 DATE 02-07-07 FAIL ❑ •NITIAL TEST BV ��- MO. DAY YR. REPAIRED BY DATE FINAL TEST BY I CERTIFIED TESTER NO. DATE MO. DAY YR. 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 BACKFLOW PREVNE MAILING/ OWNER Cupertino City CenlerVidgs Address 20400 Stevens Creek Blvd #230 Cupertino, CA. 95014 CONTACT: Bob Camarda CROSS CONNECTION SPECIALISTS BACKFLOW d��` VALVE EXPERT INSTALLATIO REPA RSPREVENT TION STING -CERTIFICATION Ase��. LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 ON SPECIALISTS, INC. SERVICE Cupertino Citv Center Bldes ADDRESS 20400 Stevens Creek Blvd. Cupertino, CA. 95014 TEL# 408-410-6517 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Ames 2000 DCA 6" 0830019 VEW 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: Comments: THE ABOVE REPORT IS CERTIFIED TO BE TRUE •INITIAL TEST CERTIFIED TESTER NO. 10866 REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 02-07-07 MO. DAY YR. 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 Nor NO.2 VALVE pt #2 - CLOSED 71GHT4 CLOSED TIGHT OPENED AT — LBS. OPENED AT LBS CLOSED TIGHT ❑ CLOSED TIGH INITIAL # Ibs..3 • Z N Ibs. !:5— LEAKED ❑ ❑ , OPDID O LBS. TEST OPENED UNDER 2.0 NOT OPEN[ 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 OPENED AT— #U11 CLOSED TIGHT ❑❑ TEST ALBS ALBS � pLBS Comments: THE ABOVE REPORT IS CERTIFIED TO BE TRUE •INITIAL TEST CERTIFIED TESTER NO. 10866 REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 02-07-07 MO. DAY YR. DATE MO. DAY YR. PASS FAIL ❑ PASS ❑ FAIL ❑