BACKFLOW CERT Cal-Air, Inc.
p 1555 South Seventh St.
• Yi L'�I San Jose, CA 95112
•' K. (408) 283.2300
Pax. (408) 293-9511
LI[1137195
BACKFLOW CERTIFICATION
SERVICE ADDRESS: •�D'I5D Rl.dyeUl Loud - Ill
DEVICE LOCATED:
RETURN TO: ACCT NO. METER NO.
Mallin Address yy`�� L` InDEVICE)INFORMATION 'E?";�tf;�:)d r`)'k',
Type IZp Size Z. MFG
Model T+6 X I— SER,NO
TYPE OF SERVICE
❑ DOMESTIC -�r IRRIGATION
CONTACT: ❑ INDUSTRIAL ❑ FIRE
Job Number REPORT OF TEST RESULTS 7V1 PASS ❑ FAIL
REDUCED REDUCED ASSEMBLY :1 ?.PRESSUREI,VACUUM'BREAKERa{II
.. , DOUBLE CHECK Airinlet Check Valve
� 3`43'df7 ;FCNO yALVE '�s;� I ;CIHE NO2Lff',3telfi( ,+ddra$ErSID
(AlVALVEn{i.„yi=, `rryi;Opened at Closed Tight
• IIR 31e ,�}V1�ll"jp'03
CLOSED TIGHT CLOSED TIGHT OPENEDAT PSID PSID
INITIAL ft,`,� LEAKED LEAKED ❑ Opened Under 1.0 PSID
( TEST T 94 B Did Not Open ❑ Leaked
+' t� + { PSID g_1- ® CLOSED TIGHT ® UNDER 2.0 PSI IIf1.IIN(`•''�A.,h-SHUTARF VALVE w<.;rtm'�it#1
µ9('+ c ❑
N � LEAKED ❑ LEAKED ❑ DID NOT OPEN NO.1 NO.2 _
(K.N,'t CLEANED CLEANED CLEANED ❑ ❑ LEAKED ❑
'rf ^t4I" ❑ CLOSED TIGHT ❑
REPLACED ❑ REPLACED ❑ REPLACED ❑
DISCS CLEANED
DISC DISC ❑ DISC(S) � ❑ ❑
113' SPRING ❑ SPRING ❑ SPRING
1C'; RE2AIRSI=Y
4uI� fallhy GUIDE ❑ GUIDE ❑ DIAPHRAGMS) ❑ REPLACED ❑
SEAT ElSEAT ❑ SEAT(S)
MODULE ❑ MODULE ❑ O-RINGS ❑ Replaced With
OTHER ❑ OTHER ❑ MODULE ❑
OTHER Type
� "1FINALrllr;'{'!� CLOSEUIGHT CLOSEDTIGHT OF N DAT
aw1,TE5T•P6`�'�'�i � PSID g•Z. PSID �'a PSID Mf
Note:Please keep in your files for 3 years.
THE ABOVE REPORT IS CERTIFIED TO BE TRUE:
REPAIRED BY: ` DATE:
FINAL TEST BY:
�'f"Op &[�;S CERTIFIED TESTER NO. [OL O DATE:
COMMENTS: �' O• z /✓'Yrq R-E70V� �1J, ���1n.1 tp}
Foster City Glendale Los Angeles Sacramento San Francisco Sana Rosa
Fresno Livermore Grange San Dieglo San Jose Salinas Whitter Gnlaw
n Cal-Air, Inc.
1555 South Seventh St.
San Jose, CA 95112
* Ph. (408) 283.2300
Pax. (408) 293-9511
' Lklr]]193
BACKFLOW CERTIFICATION
SERVICE ADDRESS: IoysSb /OfegBLiao) Cl " 6&per+7a0- - .rll-pp481d5
DEVICE LOCATED: JLC -�(A
RETURN TO: ACCT NO. METER NO.
Mailing Address }'-?�i<(J"+Ij'DEVICE!INFORMATION!"+13t�' `L�f',,
Type pli Size MFG FC6C
Model JR05- 2- SER.NO 4ro921
TYPE OF SERVICE
❑ DOMESTIC IRRIGATION
CONTACT: ❑ INDUSTRIAL ❑ FIRE
Job Number REPORT OF TEST RESULTS ❑ PASS-K FAIL
REDUCED REDUCED ASSEMBLY 'i,f:PRESSURE.VACUUM:BREAKER.?'s
DOUBLE CHECK Airinlet Check Valve
"Ft vq' a'"(s<' ^�##"CHECK UALVEi1� I!5�flGHECK VALVEwi f r"1"' ��t`-'RELIEF Q"�^ -' � Opened at Closed Tight
'�U� .l�r(P �'s ear1,uri uk
y ti*•„N0.2,_,)Gp.fbHk ia1L. xVALVEn n• PSID
prph- ` {biY,riA !�r CLOSED TIGHT CLOSED TIGHT OPENED AT PSID PSID
• I. '�NIT1'4L&�j�SttdP LEAKED ❑ LEAKED ❑
ttL�,1Opened Under 1.0 PSID
S'yn Did Not Open ❑ Leaked
t �13° PSID ❑ CLOSEDTIGHT ❑ UNDER 2.0 PSI IY i�(".^ SHUT-0FF VALVE Ss {
* 1>i iii t''• LEAKED ❑ LEAKED ❑ DID NOT OPEN N0.1 N0.2
CLEANED CLEANED CLEANED ❑ ❑ LEAKED ❑
SbS�tid ❑ CLOSED TIGHT ❑
REPLACED ❑ REPLACED ❑ REPLACED ❑
DISC ❑ DISC ❑ DISCS) ❑ CLEANED
❑
❑
tl SPRING ❑ SPRING ❑ SPRING
{�iMPAIRSiili GUIDE
r)+ dip Ibrl GUIDE ❑ ❑ DIAPHRAGM(S) ❑ ❑ REPLACED ❑
J4v bIr;iS'i ❑
" r "r;isr:.1, r'SEAT ❑ SEAT ❑ SEAT(S)
MODULE ❑ MODULE ❑
s �# V•„ rN, ❑ O•RINOS Replaced With
OTHER ❑ OTHER ❑ MODULE ❑
# I OTHER F TYPe
'FINAL �'�sy� CLOSED TIGHT CLOSED TIGHT OPENED AT
+' AaTEST(I �n;f1 PSID PSID PSID Mf
Note:Please keep in your files for 3 years.
THE ABOVE REPORT IS CERTIFIED TO BE TRUE:
REPAIRED BY: �} / 6'7-
DATE:
FINALTESTBY: ,S(n'I'f &IIfS CERTIFIEDTEST FIND. IO{iOy DATE: ZO -JQ
COMMENTS: (2C--9# li Qgj2Y--rni, Ion 4P '
• `X Can NoT TeS+ ) aii Shot o9P Value no+ closing
Foster City Glendale Los Angeles Sacrarnenlo San Francisco Santa Rosa
Fresno Livermore Orange San Diego San Jose Salinas Whittier Ontario