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Blackflow Prevention Specialists 9/22/2005CERTIFICATION OF RE-CLAIMED WATER SYSTEMS -- CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION T� • LICENSED CONTRACTOR C.C.L.# 427328 ` S r P 3750•E CHARTER PARK DR., SAN JOSE CA 96136.1356 1522-A DAY AVE.. SAN MATEO CA 94403 SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION IALISTS, INC. IIA (800) 464 -FLOW (3569) 2600 269-2650 MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir., Ste. 150 TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975 RP 3„ B22660 INTERNAL ❑ TAG LOCATION OF DEVICE main mtr# 60112842 at Portal EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PAS FAILO THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST B' . REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. DATE CERTIFIED TESTER NO. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF VALVE AIR INLET CHECKVALVE NOA N0,2 CLOSED CLOSED TIGHT{ OPENED A _ BS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL 0Ibs. 2!HTLL7j U IIba. #LBS #LBS. TEST �7 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 ❑ TEST $LBS #LBS __ OPENED AT LBS OPENED AT _ LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST B' . REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS is BACKFLOW PREVENTIOWIE LICENSED CONTRACTOR C.C.L.# 427328 SFP 2 3750•E CHARTER PARK DR.. SAN JOSE CA 95136-1356 SERVICE ADDRESS 10200 S De An2a Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer 3975 Freedom Cir., Ste. 150 Santa Clam, CA 95054 MANUFACTURER MODEL NUMBER TYPE Febco 825YA RP INTERNAL ❑ TAG EXTERNAL CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION IALISTS, INC. 31A (800) 464 -FLOW (3569) FAX(406)269-2650 CONTACT Anthony TELL! (650) 280-0048 SIZE SERIAL NUMBER 2- A021891 LOCATION OF DEVICE irrigation mtr# 60112835 at Portal IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY ���+�� CERTIFIED TESTER NO. 10220 • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO, DATE 9-08-05 MO. DAY YR. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF VALVE AIR INLET CHECKVALVE NOA NO.2 CLOSS!XHT ® CLOSED TIGHT j� v OPENEDAT "-LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL t Iha.--J1 C IW. #LBS 6 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_LBS OPENED AT_LBS TEST #LBS {LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY ���+�� CERTIFIED TESTER NO. 10220 • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO, DATE 9-08-05 MO. DAY YR. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVE r� LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION CIALISTS, INC. -ORNIA (800) 484 -FLOW (3689) 269.2650 MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir., Ste. 150 TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 825YA RP 2° A021844 ' INTERNAL ❑ TAG LOCATION OF DEVICE Irrigation mtr# 40418232 at Portal EXTERNAL - �'N IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOXO PASS FAIL❑ THE ABOVE REPORT 18 CERTIFIED TO BE TRUE INITIAL TEST BY G CERTIFIED TESTER N0. 10220 DATE 9-08-05. 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 CHECKVALVE PRESSURE I RELIEF VALVE AIR INLET CHECKVALVE NOA NO.2 CLO D T GHT,[J] CLOSED TIGHT ,� OPENED A LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL I IEa. G 0 Ba. #LBS 6 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 ❑ TEST ILSs ILBS OPENED AT _ L8S OPENED AT _LBS tLBS THE ABOVE REPORT 18 CERTIFIED TO BE TRUE INITIAL TEST BY G CERTIFIED TESTER N0. 10220 DATE 9-08-05. MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVE LICENSED CONTRACTOR C.C.L.# 427328 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 1522-A DAY AVE.. SAN MATEO CA 94403 CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION ION S:PEEIALISTS, INC. CALIF0 NIA (800) 464 -FLOW (3589) (408) 28. 2600 FAX.(408y 269-2650 SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir, Ste. 150 TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE Wilkins 975XL RP INTERNAL ® TAG EXTERNAL ❑ LOCATION OF DEVICE SIZE 2" tower roof IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASW FAIL❑ SERIAL NUMBER 534994 THE ABOVE REPORT 18 CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER N0. 10220 DATE 9-08-05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO, DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF VALVE AIR INLET CHECKVALVE NO.1 NO.2 CLOSE CLOSED TIGHT OPENED AT2- JLBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL fibs. ion. #LBS 9LBS. 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 *LB3 tLBS tLBS THE ABOVE REPORT 18 CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER N0. 10220 DATE 9-08-05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO, DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS__ CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS • 9M• BACKFLOW PREVENTIONj=c LICENSED CONTRACTOR C.C.L.# 427328 _rn' 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION IALISTS, INC, VIA (800) 464 -FLOW (3569) 3606 FERNWOOD ST., SAN MATEO CA 94403 _ FAX (408) 269-2650 SERVICE ADDRESS 10200 S. De Anja Blvd., Cupertino/X-Stevens Creek Blvd. MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir., Ste. 150 TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 909 RP 3/4° 522990 INTERNAL 19 TAG LOCATION OF DEVICE chiller roof in boiler room EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASSQd/FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY -CERTIFIED TESTER NO. 10220 . REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 9-08-05 MO. DAY YR. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE Shutoff Valves DOUBLE CHECK VALVES VACUUM BREAKERS ' DIFFERENTIAL CHECK VALVE CHECK VALVE AIR INLET CHECKVALVE PRESSURE I RELIEF NOA NO.2 VALVE qt 2 CLOSED TIGHT CLOSED TIGHT ,QD OPENEDAT LBS. OPENEDAT_LEIS CLOSED TIGHT CLOSED TIGHT❑ ❑ INITIAL i IUB. � G� OPENED UNDER 1.0 ' LBS - ❑ TEST OPENED OPENED UNDER 2.0 OR DID NOT OPEN El LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT CLOSED TIGHT ❑ CLOSED TIGHT❑ OPENED AT PENEO AT_LB UASED TIGHiQQ TEST fLBS iLBS _LBS LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY -CERTIFIED TESTER NO. 10220 . REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 9-08-05 MO. DAY YR. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS +tua 9�6' BACKFLOW PREVE • • LICENSED CONTRACTOR C.C.L.# 427328 3750•E CHARTER PARK DR., SAN JOSE CA 95136-1356 1522-A DAY AVE., SAN MATEO CA 94403 ' SERVICE ADDRESS I CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION rIONSPECIALISTS, INC. ZDV 408) 28R� 2800NIA 8001 464 -FLOW (3569) FAX (4:1269-2650 MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir., 1st floor TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XL RP V. 552186 INTERNAL N TAG LOCATION OF DEVICE chiller roof EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASO FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. REPAIRED BY FINAL TEST BY I :SLS 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 NO.1 NO.2 CLQSED TIGHT CLOSEDTIGHT OPENED AT,2--& LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL #Ibe. Q. 01bs. #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 El TEST #LBS #LBS OPENED AT _ LBS OPENED AT _ LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. REPAIRED BY FINAL TEST BY I :SLS CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS r1 I CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION BACKFLOW PREVENTI - WSPE•CILISTS, INC. LICENSED CONTRACTOR C.C.L.# 427328 _ CAL.IFORNUI i 00) 464 -FLOW (3569) 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 kx ^"'"'—(408) 269-2600 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269.2650 SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Cheek MAILING ADDRESS Tishman Speyer -,CONTACT Anthony 1 3975 Freedom Cir., Ist floor TEL# (650) 280 0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XL RP 3/4" 612975 INTERNAL ® TAG LOCATION OF DEVICE boiler roof EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX ❑ PASSJ' FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10220 • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 9-08-05 MO, DAY YR. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECKVALVE CHECK VALVE PRESSURE I RELIEF VALVE AIR INLET CHECKVALVE " NOA NO.2 CLO D GHT� CLOSED TIGHT OPENED A LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL * ICs. # ICs. *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 El CLOSED TIGHT ❑ CLOSED TIGHT TEST OPENED AT _LBS OPENED AT _LBS *LBS #LBS ILBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10220 • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE 9-08-05 MO, DAY YR. DATE MO. DAY YR.