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NO PERMIT NUMBER (2) CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS A• _ BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION BACKFLOW PREVENTION SPECIALISTS INC. LICENSED CONTRACTOR C.C.L.#427328LIFQRNIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 .�. � `� F`(408Y 269.2600 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX( B)269-2650 SERVICE ADDRESS 19500 Prunerid a Ave.,Cu ertino -Wolfe MAILING ADDRESS The Hamptons CONTACT Edgar 19500 Pruneridge Ave. TEL# 873-8800 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XL RP 11/2" 652499 INTERNAL ❑ TAG LOCATION OF DEVICE right of carpor 1 I 1 irrigation in enclosure EXTERNALS / IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PASSp FAIL❑ • 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 CHECKVALVE CLOS TIGHT CLOSED TIGHT OPENED AT LBS. OPENED AT_LEIS CLOSED TIGHT ❑ INITIAL #Ibe. #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 #LBS #LBS OPENED AT_LES OPENED AT_LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE 10220 DATE 10-26.04 INITIAL TEST BY CER C' _ TIFIED TESTER N0. MO. DAY YR. . REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS 8'"'"' CROSS CONNECTION SPECIALISTS 4�CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS • BACKFLOW PREVENTION VALVE EXPERT`-� * INSTALLATION-REPAIRS-TESTING-CERTIFICATION , BACKFLOW PREVE TIMAN SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.#427328 BY: __ _ CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 ===�dOBj 269-2600 3606 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269.2650 SERVICE ADDRESS 19500 Pruneridge Ave.,Cupertino/X-Wolfe MAILING ADDRESS The Hamptons CONTACT Edgar 19500 Pruneridge Ave. TEL# 873-8800 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975 RP 11/2" 595500 INTERNAL Q TAG LOCATION OF DEVICE left of basketball court irrigation in enclosure EXTERNAL 19 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PASSFAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF NOAN0.2 VALVE AIR INLET CHECKVALVE u CLOSED TIGHT CLOSED TIGHT OPENED AT LBS. OPENED AT—LBS CLOSED TIGHT ❑ INITIAL F Iba. #IbS. #LBS #LBS. TEST 9 ,0 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 LOS OPENED AT LBS CLOSED TIGHT TEST #LBS #LBS #LBB THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY� CERTIFIED TESTER NO. 10220 DATE 10-26-04 YY 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 BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 1 ? INSTALLATION-REPAIRS-TESTING-CERTIFICATION P.N1Ck�;�V�.. ,�.eY�lgr�9.s• �BACKFL IV W `PREVENTION SPECIALISTS, INC. LICENSED Cown4UMR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER -95'136-1356 (408)269.2600 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269.2650 SERVICE ADDRESS 19500 Pruneridge Ave.,Cupertino/X-Wolfe MAILING ADDRESS The Hamptons CONTACT Edgar 19500 Pruneridge Ave. TEL# 873-8800 Cupertino,CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XL RP 11/2, 532158 INTERNAL ❑ TAG LOCATION OF DEVICE prop line 40'from curb carport 21 irrigation EXTERNAL ® in enclosure IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PAS FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF AIR INLET CHECK VALVE NOA NO.2 VALVE CLOS I�GHT CLOSED TIGHT OPENED AT LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL 0lbs. . LC/� f lbs. #LBS 0 LSS. 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 El TEST *LBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10220 DATE 10-26-04 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMSCROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS INSTALLATION-REPAIRS-TESTING-CERTIFICATION V 1 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 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269.2650 SERVICE ADDRESS 19500 Pruneridge Ave.,Cupertino/ -Wolfe NUV 0 9 2004 j MAILING ADDRESS The Hamptons CONTACT Edgar 19500 Pruneridge Ave. Y'— _:_ 873-8800 Cupertino,CA 95014 MANUFACTURER, MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975 RP 11/2" 595894 INTERNAL ❑ TAG LOCATION OF DEVICE next to carport 146 irrigation in enclosure EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASSP/FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF NOA NO.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT CLOSED TIGHT OPENED ATS,a LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL $lbs. 8 •r�- 0Ibs. #LBS M 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 $LBS $LBS $LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BV CERTIFIED TESTER NO. 10220 DATE 10-26-04 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. ,