Loading...
NO PERMIT NUMBER (3) CERTIFICATION OF RE-CLAIMED WATER SYSTEMS ��_ -���///,,,...... CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS A' BACKFLOW PREVENTION VALVE EXPERT V . INSTALLATION-REPAIRS.TESTING-CERTIFICATION BACKFLOW PREVENTIONSPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER PARKOR:,SAN JOSE CA 95136-1356 (406)269-2600 3808 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650 E ' ' iVFD { Nov 1 3 2003 SERVICE ADDRESS 19500 Ptuneridge Ave.,Ctrl ttino/X-Wolfe MAILING ADDRESS T_ e Hamptons CONTACT EdgBY' 19500PnmeridgeAve. TEL# 873-8800 Cupertino,CA 95014CA 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 1F DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASS FAIL❑ . • en ._._...._... REDUCED-PRESSURE DEVICES PRESSURE TYPEr ,z DOUBLE CHECK VALVES -- - VACUUM BREAKERS - RPP VALVES DIFFERENTIALCHECK VALVE CHECK VALVE PRESSURE I RELIEF N0.1 -,. N0.2 VALVE AIR INLET CHECK VALVE CLOSED TLGHT CLOSED TIGHT-'- OPENED AT-.._LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL #lbs._ __-_ p lbs. #LBS #LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 I� LEAKED LEAKED nOR DID NOT O�P1EN OR DID NOT OPEN Cl LEAKED ❑ REPAIRS Kep/Q(Ed P I /gCID RVIOr-44 MATERIALS 1 Ce`lC�ll DIY,``^^ L"Ct� RU"/UP/� y{�I USED �l CC O�'IX iN pralI(Ye/� q It, FINAL CLOSED GHT CLOSED TIGHT• i' CLOSED TIGHT❑ ,_. 7p� OPEN DA '/ TEST #LBS �• A #LBS E T_LBS OPENED AT_LBS #LBS i THE ABOVE REPORT IS CERTIFIED TO BE TRUE - -- r I NITIAL TEST -- - CERTIFIED TESTER NO. - .:DATE.,11-07-03 BY���-.�..V`. . . 9815 ,.MO. DAY YR.' REPAIRED BY . : t ', .,.i . . . ... ....... . FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. o„ CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS _,' , INSTALLATION-REPAIRS-TESTING-CERTIFICATION %ACKFLOW PREVENTION SPECIALIST ST ED . LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (f Py FLOW(356 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-800 NOV 1 3 2003 3608 FERNWOOD ST.,SAN MATEO CA 94403 SERVICE ADDRESS 19500 Pmneridge Ave.,500 Pmneridge AveCu�rtino/X-Wolfe BY•-Wolfe BY•---- MAILING ADDRESS The Hamptons CONTACT Edgar 19500 Pnrneridge Ave. TEL# 873-8800 Cupertino,CA 95014CA 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 PASS® 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 CHECK VALVE CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENEOAT_LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL 0Ibs. #Ibs. #LBS #LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 n,, LEAKED /a,l n LEAKED IpA OR DID NOT OPEN OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS Inc ALG P,,IO,,C`r� K v4jq C.el Rp'QCe& AND '41 CrlRl� )& ��."C/�eLC CN�C�IQ MATERIALS USED VAI U 9- FINAL FINAL CLOS–ErD TIGHT CLOSED TIGHT a k CLOSED TIGHT❑ TEST 0 HIS / • ALBS OPENED AT_LBS OPENED AT_LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE I NITIAL TEST BY —CERTIFIED TESTER N0. 9815 DATE 11-07-03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR.