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BACKFLOW��yy CERTIFICATION OF RE-CLAIMED WATER SYSTEMS 1"° CROSS CONNECTION SPECIALISTSBACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS INSTALLATION -REPAIRS -TESTING -CERTIFICATION 3a y qn. %ACKFLOW 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 20525 Marian Dr., Cupertino/X-N. DeAnza MAILING ADDRESS Johnson Controls World Services CONTACT SteVC 7777 Gateway Blvd M/S NWK15-203 TEL# (650) 336-5133 Newark, CA 94560 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins eg 37�6' RP 3" c6g91 INTERNAL ❑ TAG LOCATION OF DEVICE main water gp rj EXTERNAL ,Aj PQ SS IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS Box PASS{() FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY TIFIED TESTER N0. 2656 DATE 08-10-02 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 CHECKVALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSE( HT CLOSEDTIGHT .OPENED AT LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL # Ibs. # 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 _LBS OPENED AT _LBS ILBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY TIFIED TESTER N0. 2656 DATE 08-10-02 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 BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION Si�C44�9r4• *BACKFLOW PREVENTION SPECIALISTS, INC. E 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 20525 Mariam Dr., Cupertino/X-N. DDAnza MAILING ADDRESS Johnson Controls World Services CONTACT Steve 7777 Gateway Blvd M/S NWK15-203 TEL# (650)336-5133 Newark, CA 94560 MANUFACTURER MODEL NUMBER TYPE Watts INTERNAL Ca TAG EXTERNAL ❑ 009 0 LOCATION OF DEVICE roof chiller SIZE SERIAL NUMBER 11• 36586 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASS Iia FAIL❑ Int AnWt KbFUN I IS CERTIFIED TO BE TRUE INITIAL TEST BYCERTIFIED TESTER NO. 2656 • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO, DATE 07-03-02 MO. DAY YR. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECKVALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSEDTIGHT � CLOSED TIGHT �_ OPENEDAT3d LBS. 'OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL a lb,. _ # lbs. #LBS # LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED Cl OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT ❑ TEST ALBS #LBS OPENED AT_LES OPENED AT_LBS S LBS Int AnWt KbFUN I IS CERTIFIED TO BE TRUE INITIAL TEST BYCERTIFIED TESTER NO. 2656 • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO, DATE 07-03-02 MO. DAY YR. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION s+4arG/b ?.�• %ACKFLOW PREVENTION SPECIALISTS,%INC. - - LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 464 -FLOW (3569) 37S(r-E CHARTER PARK DR., SAN JOSE C/795i36.1356 (4081269.2 ----- 1522-- DAY AVE., SAN MATEO CA 94403 FAX (408) 269-2650 SERVICE ADDRESS 20525 Marian Dr., Cuperlin0/X-N. DeAnza MAILING ADDRESS Johnson Controls World Services CONTACT Steve • 7777 Gateway Blvd WS.NWK15-203 TEL# (650) 336-5133 Newark, CA 94560 MANUFACTURER MODEL NUMBER TYPE Watts INTERNAL TAG EXTERNAL ❑ 009 RP LOCATION OF DEVICE roof-boiler/chiller SIZE SERIAL NUMBER 1•, G37893— IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX[] PASSZ—FAI40 I HL ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY !i'—"' CERTIFIED TESTER NO. 2656 DATE 07-03-02 • 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 i CHECKVALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE � CLOSED T�IyGFTT--CLOSED TIGHT ❑ OPENEDAT%,�V_LBS. OPENEDAT _LBS CLOSEDTIGHT ❑ INITIAL # Ibs. 6o I # Ibs. #LBS # LES, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED Iy,I V\ 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 f LBS I HL ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY !i'—"' CERTIFIED TESTER NO. 2656 DATE 07-03-02 • 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 BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS �, ��j INSTALLATION -REPAIRS -TESTING -CERTIFICATION . .. SMms/pps Grp., 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) 289-2650 A SERVICE ADDRESS 20525 Mariaru Dr., Cupertino/X-N. DeAnza MAILING ADDRESS JO11nSOn COntrO1S WOrld SeryiCCS CONTACT Steve 7777 Gateway Blvd M/S NWK15-203 TEL# (650) 336-5133 Newark, CA 94560 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805 DC 3° 6055 INTERNAL ❑ TAG LOCATION OF DEVICE LL✓—G2f— EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PASS❑ FAIL. THE ABOVE REPORT 15 CERTIFIED TO BE TRUE -� INITIAL TEST BY.. - Z �' ' - _ . CERTIFIED TESTER Nf • REPAIRED BY .. ` DOTE FINAL TEST BY CERTIFIED TESTER NO. 2656 DATE `07-03-02 MO. DAY 'YA. DATE MO. DAY YR. `�l REDUCED PRESSURE DEVICES - _ PRESSURE TYPE ' DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF NOA NO.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT ❑ ' CLOSED TIGHT ❑ OPENED AT _ LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL 0Ibs. IsIbs. #LBS ALBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED Cl OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT CLOSED TIGHT ❑ CLOSED TIGHT El TEST ALBS- ALBS I OPENEDAT_LBS I OPENED AT _LBS I SLBS THE ABOVE REPORT 15 CERTIFIED TO BE TRUE -� INITIAL TEST BY.. - Z �' ' - _ . CERTIFIED TESTER Nf • REPAIRED BY .. ` DOTE FINAL TEST BY CERTIFIED TESTER NO. 2656 DATE `07-03-02 MO. DAY 'YA. DATE MO. DAY YR. `�l CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS _,' INSTALLATION•REPAIRS-TESTING-CERTIFICATION 3�y��9ae• �ACKFLOW 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 20525 Marian Dr., Cuperlino/X-N. DeAnza MAILING ADDRESS Johnson Controls World Services CONTACT SleVe 7777 Gateway Blvd M/S NWK15-203 TEL# (650) 336-5133 Newark, CA 94560 MANUFACTURER MODEL NUMBER TYPE Watts 009 INTERNAL ❑ TAG _ EXTERNAL ❑ 0 LOCATION OF DEVICE roof Chiller SIZE SERIAL NUMBER 1"=37f�f✓� IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS, FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO, 2656 DATE 08-09-02 MO. DAY YR. • REPAIRED BY DE f FINAL TEST By J %/ �jj�_iC CERTIFIED TESTER NO. DATE 1. 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 CHECK VALVE N0.1 N0.2 CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENEDAT_LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL alba. #Ibs. #LBS #LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED (L LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ ����c:-G+� /7 REPAIRS „! AND /;7 %` /2 MATERIALS br,.,rar � '-LS USED FINAL CLOSE TIGHT CLOSED TIGFTT , L/ CLOSED TIGHT C1TEST #LBS 7 #LBS OPENED AT ^/LES OPENED AT_LOS ALBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO, 2656 DATE 08-09-02 MO. DAY YR. • REPAIRED BY DE f FINAL TEST By J %/ �jj�_iC CERTIFIED TESTER NO. DATE 1. MO. DAY YR.