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BACKFLOW PREV REPORT CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS '�`"° , BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION S+4arctw?�• ., • BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 �Y`i� 1. V 6BF3E0 NIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)2 2600 1522-A DAY AVE., SAN MATEO CA 94403 4 0OX( 269-2650 SERVICE ADDRESS 22840 Mercedes Rd.,Cupertino RY. --- MAILING ADDRESS The Marianisl Center CONTACT Steve 22622 Marianist Way TEL* 253-6979 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009M2 RP 2" 131622 INTERNAL ❑ TAG LOCATION OF DEVICE mtr# 19772246 EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASS�I FAIL❑ .I 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 CHECKVALVE CLOSED TIGHT Z CLOSED TIGHT OPENED AT5' a LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL 0Ihe. Q M lbs. 11LBS #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 ❑ OPENED AT_LBS OPENED AT_LBS CLOSED TIGHT❑ TEST ALBS OLBS ILBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY�FIED TESTER NO. <f� 6 S b DATE 3-17-03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS ; .=4 BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 �� r-+,N`I4�- (800)484-FLOW(3589) 3750-E CHARTER PARK DR.,SAN JOSE CA 95138-1358 ' "''�`"r ( -28 1522-A DAY AVE.,SAN MATEO CA 94403F )2 -2850 SERVICE ADDRESS 22840 Mercedes Rd.,Cupertino MAILING ADDRESS The Marianist Center CONTACT Steve 22622 Marianist22622 Mariattist Way TEL# 253-6979 Cupertino,CA 95014CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009M2 RP 2" 100918 INTERNAL ❑ TAG LOCATION OF DEVICE mtr# 19772246 EXTERNAL IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASS FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOS EDTIGHTO CLOSED TIGHT '�" OPENEDAT3�- LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL #Iba. /• #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 ❑ OPENED AT_LBS OPENED AT_LBS CLOSED TIGHT❑ TEST ALBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. Z�`S� DATE 3-17-03 MO. DAY YR. • REPAIRED BY DOTE FINAL TEST BY CERTIFIED TESTER NO, DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS yyy CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS V =. BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION • SMxrGats�9sa BACKFLOW 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 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2850 SERVICEADDRESS 22840 Mercedes Rd.,Cupertino MAILING ADDRESS The Marianist Center CONTACT Steve 22622 Marianist Way TEL# 253-6979 Cupertino,CA 95014CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 909 RP 3/4" 256604 INTERNAL ® TAG LOCATION OF DEVICE boiler make up boiler pad 1 EXTERNAL ❑ i IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASO FAIL❑ } • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF , NO.1 NO.2 VALVE AIR INLET CHECK VALVE .f CLOS�/p TIGHT T CLOSED TIGHT OPENED AT�LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL #Ibs. ( '� #Ibs. #LBS ALBS, 1� TEST OPENED UNDER 2A OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN Cl LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ CLOSED TIGHT❑ TEST #LBS #LBS OPENED AT_LBS -OPEN ED AT_LBS It LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. �d`7�L DATE 3-17-03' MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR.