NO PERMIT NUMBER (2) Cal-Air, Inc.
1555 South Seventh St.
LAIR' San Jose, CA 95112
Ph. (408) 283.2300
Pax. (408) 293.9511
tkrl)119]
BACKFLOW CERTIFICATION
SERVICE ADDRESS: 162500 jej*tlltr� (Z ' _ °tPPk a10(9
DEVICE LOCATED: efd9UlCL,.1 /CJ
RETURN TO: ACCT NO, METER NO.
Mallin Address `� '+k+`2ti359)t E.'OEVICE',FO ...., '; r
?ar r' '��� INFORMATIO�N�S]r.y,�;?'CLld;.h,��'
Type ' Size MFG
Model 7tA SER.NOB Jy.
TYPE OF SERVICE
❑ DOMESTIC . % IRRIGATION
CONTACT: ❑ INDUSTRIAL ❑ FIRE
Job Number REPORT OF TEST RESULTS ❑ PASS ❑ FAIL
REDUCED REDUCED ASSEMBLY �ChCPRE55URErVA000MBRBAKER�S;�1.
,A,lG DOUBLE CHECK .Air Inlet Check Valve
{�tj �1 `ws{�}i } {CHECKVALVE� q° (gC�HECK VAIiVE }v 'rYr " RHLfEFy�rr`I '±•3kE°r`•1`Opened at Closed Tight -
w�i><`;i'�r}I✓ gFk'it.vi�(ki"1l1N0.18tI3 &tiN �I.isi�Ii'klN0.2�h)I :'y,-34' � ' !:tIlly
i "vnLVE'NI{*I)IIE� hi1 PSID
• 'Itl'jq�' nptCLOSED TIGHT CLOSED TIGHT OPENED AT PSID PSID
� INIRTItALrl I LEAKED ❑ LEAKED ❑ 8 Opened Under 1.0 PSID
yr `IrTE{T " Did Not Open ❑ Leaked
ry6 '. PSID ❑ CLOSEDTIGHT
a _ ❑ UNDER 2.O PSI �lvll-tau SHUT-0F.F VALVErLu: iln}t�
c.� n1X ❑
°�,'i0Pn! , LEAKED ❑ LEAKED ❑ DID NOT OPEN N0.1 N0.2
='%''114 CLEANED CLEANED CLEANED LEAKED
il�VIillqtr , ❑ ❑
]�
dt tiw �rbrvnk.' CLOSED TIGHT
RIA,
1t' 'Trf4l REPLACED ❑ REPLACED ❑ REPLACED ❑
"�' `1'- �x ❑ DISC ❑ DISCS ❑
n I ilt;r DISC DISCS) ❑ ❑ CLEANED
N ;ih�`111v=�.M ❑ SPRING ❑ SPRING ❑
' N,'REPAI P SPRING
7-"nt+;;,,,.,4tk`plyl.j GUIDE ❑ GUIDE ❑ DWPHRAGM(S) 11 1-1REPLACED
'r ❑
r§� �'SEAT ❑ SEAT ❑ SEAT(S) ❑
MODULE ❑ MODULE ❑ O•RINGS ❑ Replaced With -
` .p OTHER
❑ OTHER ❑ MODULE ❑
A.r];;iutlffiut,3. OTHER Type
��.FINACt"1`�r" CLOSED TIGHT CLOSED TIGHT OPENED AT
a¢n!1+sTE3T '�h"n,5 PSID PSID PSID - Mf
Note:Please keep in your files for 3 years,
THE ABOVE REPORT IS CERTIFIED TO BE TRUE:
REPAIRED BY: d r DATE:
FINAL TEST BY: SCOtt B✓1I�$ CERTIFIED TESTER NO. IO(.'Sz— DATE: 3.19,09
COMMENTS: �C9B — .//Y'ry4hnDn
Foster City Glendale Los Angeles Sacramento San Francisco Santa Rosa
Fresno Liveimoia Orange San Diego San Jose , Salinas Whittier Ontario