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NO PERMIT NUMBER - BF CERTIFICATION OF RE-CLAIMED WATER SYSTEMS � CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS PAS. INSTALLATION-REPAIRS-TESTING-CERTIFICATION BACKFLOW PREVENTION SPECIALISTS,- INC-: LICENSED CONTRACTOR C.C.L.#427328 ��"" OW(356 CALIFORNIA (80 Ilt+cw�LOW(3569)3750-E CHARTER PARK DR.,SAN JOSE �'� 1522-A DAY AVE. SAN MATEO CA 94403 A 95136-1356 FAX 269-26 9- `J©v 0 FAX(406)26 0 0 SERVICE ADDRESS 20215 Stevens Creek Blvd.,Cupertino/X-Vista Dr btwn Wolfe&Sunnyval T as toga.a i"— MAILING ADDRESS Santa Clara County Fire Dept. CONTACT Steve 14700 Winchester Blvd TEL# 408-378-4010 Los Gatos,CA 95032 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 825Y RP 2 A247246 INTERNAL ❑ TAG LOCATION OF DEVICE irrigation EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX PASSIM FAIL❑ • REDUCED PRESSURE DEVICES VVV ��\ PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF NO.1 NO.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT ❑ CLOSED TIGHT 10 OPENED AT 2. 7 LBS. OPENED AT_LBS CLOSED TIGHT Cl INITIAL %lbs. .7 . #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 Cl TESTOPENED AT_LBS OPENED AT LBS #LBS lLBS _ lLBB THE ABOVE REPORT IS(CERTIFIED TO BE TRUE/ INITIAL TEST BY L Lln CERTIFIED TESTER NO-26Z--10066DATE 11-01--05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. 4 CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTSBACKFLOW PREVENTION VALVE EXPERT I NSTALLATI ON-REPAI RS-TESTI NG-CERTI FICATtON BACKFLOW PREVENTION SPECT L1STS;7INQ LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (8 0)416,4-FVOW(35696 05 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2 500 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2g 50 SERVICE ADDRESS 20215 Stevens Creek Blvd.,Cupertino/X-Vista Dr btwn Wolfe&Sunnyvale/Saratoga Cal Water Los Altos MAILING ADDRESS Santa Clara County Fire Dept. CONTACT Steve 14700 Winchester Blvd TEL# 378-4010 Los Gatos,CA 95032 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 825Y- -_- _ .-- --RP —2 — - 205258 INTERNAL ❑ TAG LOCATION OF DEVICE on Vista Dr main water mtr#32601822 EXTERNAL 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 I RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT ❑ CLOSED TIGHT 10 OPENED ATLBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL #Its. -7 • +Z #Ibs. #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 ❑ OPENEDAT_LBS OPENED AT_LBB CLOSED TIGHT❑ TEST ALBS *LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY C2�NGw1 hP11��4a�'� CERTIFIED TESTER NU. DATE 11-0 -05 MO. DAY YR. REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR.