Loading...
BACKFLOWCROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS .�. BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS INSTALLATION -REPAIRS -TESTING -CERTIFICATION OBACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 484 -FLOW (3569) 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 (408) 269-2600 1522-A DAY AVE., SAN MATEO CA 94403 - FAX (408) 269-2650 • SERVICE ADDRESS 10200 S De Anja Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS TiShmen Speyer 444 Castro St., Ste. 520 Mountain View, CA 94041 MANUFACTURER MODELNUMBER TYPE FebCo 825YA RP INTERNAL ❑ TAG EXTERNAL El CONTACT AnUlOUY T E LO (650) 280-0048 SIZE SERIAL NUMBER 2° A021844 LOCATION OF DEVICE irrigation mtr# 40418232 et Portal IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASSJ3'�II?AIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. �v"DATE 09-26-02 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 CHECK VALVE NO.1 NO.2 CLOS TIGHT CLOSED TIGHT OPENED AfZj" LBS. OPENEDA7 _LBS CLOSED TIGHT ❑ INITIAL #Ibs. 0,6 #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 FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT ❑ TEST OPENEDAT _LBSFo ENED AT _LBS NUBS #LBS 0LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. �v"DATE 09-26-02 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS f.R°°tlj�, CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS INSTALLATION -REPAIRS -TESTING -CERTIFICATION OBACKFLOW 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 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269.2650 SERVICE ADDRESS 10200 S De Anja Blvd., Cuper ino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT AnthonY 444 Castro St., Ste. 520 Mountain View, CA 94041 MANUFACTURER MODEL NUMBER TYPE Febco 825YA RP INTERNAL ❑ TAG EXTERNAL LOCATION OF DEVICE TEL# (650)280-0048 SIZE SERIAL NUMBER 2" A021891 mtr# 60112835 at Portal IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PAS$el-EAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.yb"DATE 09-26-02 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/RELIEF NOA NO.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT—CLOSED TIGHT,2= OPENEDATZ'9:�_ LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL a Ibs. 8. v p Ibs. #LBS p 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 pLBS #LBS OPENED AT _ LBS OPENED AT _LBS pLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.yb"DATE 09-26-02 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ..�. CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION GBACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.6 427328 CALIFORNIA (800) 464 -FLOW (3589) 3750-E CHARTER PARK DR., SAN JOSE CA 95136.1356 (408) 2694600 FAX (408) 269-2650 1522-A DAY AVE., SAN MATEO CA 94403 DIFFERENTIAL t� SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT AnftnY 444 Castro St., Ste. 520 TEL# (650) 280-0048 Mountain View, CA 94041 MANUFACTURER MODEL NUMBER TYPE S1ZE SERIAL NUMBER Wilkins 975 RP 3° B22660 INTERNAL Cl TAG LOCATION OF DEVICE main mtr# 60112842 at Portal EXTERNAL IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS FAIL❑ IME ABOVE REPORT 15 CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. ':'Z `. 6�.6 DATE 09-26-02 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 / RELIEF N0.1 N0.2 VALVE AIR INLET CHECKVALVE INITIAL CLOSED TIGHT SIbc CLOSEDTIGHT 01ba u OPENEDAT2/ LBS. OPENEDAT_LBS YLBS CLOSED TIGHT ❑ #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 ALBSALBS OPENED AT _LBS OPEN ED AT _LBS S LB5 IME ABOVE REPORT 15 CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. ':'Z `. 6�.6 DATE 09-26-02 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 CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS �' v BACKFLOW PREVENTION EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION �vlilpb��'0' OBACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 464 -FLOW (3589) 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 (408) 269-2600 FAX (408) 269-2650 1522-A DAY AVE., SAN MATEO CA 94403 DIFFERENTIAL r U SERVICE ADDRESS 10200 S De Anza Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer 444 Castro St., Ste. 520 Mountain View, CA 94041 MANUFACTURER MODEL NUMBER TYPE Wilkins 975XL RP INTERNAL ® TAG EXTERNAL ❑ LOCATION OF DEVICE CONTACT AnthOnY TEL# (650) 280-0048 tower roof SIZE SERIAL NUMBER 2" 534994 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY //3,G CERTIFIED TESTER NO. ^Z6 <7G DATE 09-26-02 • REPAIRED BY FINAL TEST BY CAM CERTIFIED TESTER NO. DATE MO. DAY YR. 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 NO.1 NO.2 Cl CLOSED TIGHT CLOSED TIGHT OPENED AT LBS. OPENED AT_LBS CLOSED TIGHT Cl INITIAL # tbs. fA # tbs. #LBS # LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN Cl OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT CLOSED TIGHT ❑ CLOSED TIGHT ❑ TEST #LBS #LBS _ LBS OPENEDATOPENED AT _LBS $LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY //3,G CERTIFIED TESTER NO. ^Z6 <7G DATE 09-26-02 • REPAIRED BY FINAL TEST BY CAM CERTIFIED TESTER NO. DATE MO. DAY YR. MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ���°1/))) CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS v� BACKFLOW PREVENTION VALVE EXPERT 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 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269-2650 • SERVICE ADDRESS 10200 S. De Anza Blvd., Cupertino MAILING ADDRESS Tishman Speyer CONTACT Anthony 444 Castro St., Ste. 520 TEL# 650-280-0048 Mountain View, CA 94041 MANUFACTURER MODEL NUMBER Watts 909 INTERNAL ® TAG EXTERNAL ❑ TYPE SIZE SERIAL NUMBER RP 3/4„ 522990 LOCATION OF DEVICE Chiller Roof in boiler room IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PASS® FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY tel/"-' CERTIFIED TESTER NO. 2656 DATE 9/26/02 • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. 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 NO.1 NO.2 CLOSED TIGHT ® CLOSED TIGHT ® OPENED AT 3.0 LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL # lbs. 9.0 # Ib. #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_Las OPENED AT_LBS TEST #LBS SUBS #LOS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY tel/"-' CERTIFIED TESTER NO. 2656 DATE 9/26/02 • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTSBACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION OBACKFLOW 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 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269-2650 • SERVICE ADDRESS 10200 S De Anne Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer 444 Castro St., Ste. 520 Mountain View, CA 94041 MANUFACTURER MODEL NUMBER TYPE Wilkins 975XL RP INTERNAL ® TAG EXTERNAL ❑ CONTACT AndIOny TEL# (650) 280-0048 LOCATION OF DEVICE boiler I2ae SIZE SERIAL NUMBER 3/4" 612975 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. DATE 09-26-02 MO. DAY YR. • REPAIRED BY FINAL TEST BY 6MC4 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 N0.1 N0.2 CLOSEDTIGHT CLOSED TIGHT OPENEDAT 2_Z LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL #Ibs.'al #Ibs. #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 TEST #LBS #LBS OPENED AT—UBS OPENED AT _LBS ILBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. DATE 09-26-02 MO. DAY YR. • REPAIRED BY FINAL TEST BY 6MC4 CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROS$ CONNCTION CONTROL CONSULTANTS , BACKFLOW PREVENTION VALVE EXPERT E 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 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269-2650 SERVICE ADDRESS 10200 S De Anna Blvd., Cupertino/X-Stevens Creek MAILING ADDRESS Tishman Speyer CONTACT AnthOnY 444 Caslm St., Ste. 520 Mountain View, CA 94041 MANUFACTURER MODEL NUMBER TYPE 975XL INTERNAL ® TAG EXTERNAL ❑ 1T7 TEL# (650)280-0048 SIZE SERIAL NUMBER V 552186 LOCATION OF DEVICE Chiller Rev IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSpFAILO THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.DATE 09-26-02 • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE / RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE INITIAL CLOSED TIGHTeff o [be. /0• 2, CLOSED TIGHT # lbs. OPENED AT 2_L LBS. OPENED AT_LBS #LBS CLOSED TIGHT ❑ tl LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED Cl LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT ❑ TEST MLBS #LBS OPENED AT _LBS OPENED AT _LBS I LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.DATE 09-26-02 • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. MO. DAY YR.