BACKFLOW Cal-Air, Inc.
1555 South Seventh St.
• p "� Ifi� Sen Jose, CA 95112
' Ph. (408) 283.2300
Pax. (408) 293,9511
�enmws
BACKFLOW CERTIFICATION
SERVICE ADDRESS: p�IUySD Afd
w(4w Gt. A-p�l{ BIdQ
DEVICE LOCATED: X"p fyiw 7A '
RETURN TO: ACCT NO. METER NO.
Mailin Address T,�!•7p.'Qpoan;�.,t,:i!DEVICEINPORMATION✓r.s:r�.=I�.r lir.
Type D Size `l,tr MFG r 6CO
Model ?( 5 Z. SER.NOI39g y
TYPE OF SERVICE
❑ DOMESTIC 5--IRRIGATION
CONTACT: ❑ INDUSTRIAL ❑ FIRE
Job Number REPORT OF TEST RESULTS ®, PASS ❑ FAIL
REDUCED REDUCED ASSEMBLY ^!,:PRESSURE'.VACUUMBREAKER.`4,
DOUBLE CHECK Air Inlet Check Valve
t Pia s ('pt"I_ c° CHECKVALVE 4r �'ICHECK VALVE x `I'f'�f'RELfIEFRI"�`�"'111, I Opened al Closed Tight
Pn nt� iluamT.xi �,1 t�iy��i luol knl IFS;' W.f p iyri> rl ?'li t A 9
�nfdN',t W 6T tI:N0.1;€#I tok+ it �idafliir+ NO2„..+ I: iur..ell��• hri�`iVALVE�a"UPR PSID 3 5
• brk�" �j¢�F' CLOSED TIGHT CLOSED TIGHT OPENED AT PSID PSID
` ' IINITIALh.'
LEAKED LEAKEDV. I N yjt � Opened ened Under 1.0 PSID
TEST
4114N. Did Not Open ❑ Leaked
ity(i PSID_ CLOSEDTIGHT ❑ UNDER 2.0 PSI ❑ „`„''yJl� ��'xSHUT-0F.FcVALV0WP,1Y�l�B%
>�" 4`LI$r4 LEAKED LEAKED
❑ DID NOT OPEN N0.1 N0.2
��.,' '015 CLEANED ❑ ❑
CLEANED CLEANED LEAKED111 ❑
n �' '�" CLOSED TIGHT
taw 6
REPLACED ❑ REPLACED ❑ REPLACED ❑ .
sU"'' ❑
DISC ❑ DISC DISCS) ❑ ❑ CLEANED
..Vu . •'''� e} },I SPRING ❑ SPRING ❑ SPRING ❑
REEEPAIRS't
t ❑ GUIDE ❑ DIAPHRAGMS ❑
a�
_011.1
,,((6}}���I GUIDE I ) ❑ ❑ REPLACED
SEAT ❑ SEAT ❑ SEAT(S)
MODULE ❑ MODULE ❑ O-RINGS ❑ Replaced With
•' ,' ' '{t'I?OTHER ❑ OTHER ❑ MODULE ❑
mss:=tI JOTHER Type
as644A413CLOSED TIGHT CLOSED TIGHT OPENED AT l
edvaxu PSID PSID PSID
mt#;.rzziklTESTAs..:,;;i Mf
Note:Please keep in your files for 3 years.
THE ABOVE REPORT IS CERTIFIED TO BE TRUE:
REPAIRED BY: n -1 DATE:
FINAL TEST BY: _ S(A N• Rol I. S / CERTIFIED TESTER NO. /0(0 572- DATE:
COMMENTS: te0A (Fro O+ )/o pilo tti)
•
Fosrar City Glendaln Los Angeles Sacramento Snn Francisco Santa Rosa
Fresno Lmennoie Cran9e San Dialryu San Jose alinas Whittler Cntano
Cal-Air, Inc.
1555 South Seventh St.
San Jose, CA 95112
Ph. . (408) 283.2300
1-•aX. (408) 293.9511
LIt Y 137195
BACKFLOW CERTIFICATION - -
SERVICE ADDRESS: I,NVD l9ttne.J f cLLpe��•,„o . - "P48laq
DEVICE LOCATED: .J Ot A—
RETURN TO: ACCT NO. METER NO.
Mailing Address DEVICi f+j
Type /�p Size _ ” MFG WI KawS "Zv2n
Model SER.NO Z 3I -f&5
TYPE OF SERVICE
❑ DOMESTIC ❑ IRRIGATION
CONTACT: INDUSTRIAL ❑ FIRE
Job Number REPORT OF TEST RESULTS PASS ❑ FAIL
REDUCED REDUCED ASSEMBLY q'PRESSUREVACUUM'�BREAKER�i±�
DOUBLE CHECK Air Inlet Check Valve
k'(' tlf ''� r+rCHECK VA;LVE��}{ �CHECK VALVE, !4 •) 'n'r;p RELIEF Tim" 'Opened at Closed Tight
i .1, .i )4t� IN01x t�s m a k s� I nlrwCm x1
. _m N0.2C-. „k1 " dt ..3nVALVEI. .M PSID
kiiy ! tCLOSED TIGHT CLOSED TIGHT
�, OPENEDAT _�PSID PSID
rIU
e IrNITIAL LEAKED 11 J1RImrltfs �( � LEAKED Opened Under 7.0 PSID
1TEST "k S� ❑ LEAKED ❑ Leaked
) 3 t 1" rg ` Did Not Open
�r� PSID_ ❑ UNDER 2.0 PSI ❑ �.�7N��a�SHUT'-0FF VALVE uwi?`.�r'
® CLOSED TIGHT
LEAKED ❑ DID NOT OPEN NO 1 NO.2
a 'tx ; s�
fl�tn, CLEANED CLEANED CLEANED ❑ El LEAKED El o :a
❑ CLOSED TIGHT ❑
• j1p,1*1 II� REPLACED ❑ REPLACED ❑ REPLACED ❑
a�ji '�^1�s" , ❑
DISC DISC ❑ DISC(S) ❑ ❑ CLEANED ❑
Z
REP IRS SPRING ❑ SPRING ❑ SPRING ❑
, 3�GUIDE ❑ GUIDE ❑ DIAPHRAGM(S) ❑ ❑ REPLACED ❑
•M1 {{YtE(r 91
• SEAT ❑ SEAT ❑ SEAT(S) ❑
1r� yp MODULE ❑ MODULE ❑ O-RINGS ❑ Replaced With
•{"' "�'! 'l OTHER OTHER ❑ MODULE ❑
hI,!tZ i
OTHER Type
`yts`FINAL �S• CLOSEDTIGHT CLOSED TIGHT OPENED AT
T.�iizx� -
EST•s�A !' •ID PSID ��� PSID 3•m PSID Mf
Note:Please keep in your files for 3 years.
THE ABOVE REPORT IS CERTIFIED TO BE TRUE:
REPAIRED BY: DATE:
FINALTESTBY: Sk',yr 'B,,u"S CERTIFIED TESTER NO. DATE: 3 /9 Opt
COMMENTS: �I - l0 y6 �.G9/F ropf i-Or
•
Fostar City Glendale Los Angeles Sacramento San Francisco Santa Rosa
Fresno Livermore Orange San Diego San Jose Salinas Whittier Ontario