BACKFLOW REPORT CERTIFICATION OF RE-CLAIMED WATER SYSTEMS tb�e°0' CROSS CONNECTION SPECIALISTS
CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS , 1' BACKFLOW PREVENTION VALVE EXPERT
INSTALLATION-REPAIRS-TESTING-CERTIFICATION
CALIFORNIA (800)464-FLOW(3569) •���
LOCAL(408)269.2600 S LICENSED CONTRACTOR C.C.L.#427328
FAX(408)269.2650 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356
%ACKFLOW PREVENTION SPECIALISTS, INC.
MAILING/OWNER Verona Owners Assoc.C/O Boardwalk Investment Group INC SERVICE Verona Owners Assoc.
Address ADDRESS 317 Lennon Lane Ste. 200 20488 Stevens Creek Blvd.
Walnut Creek,CA. 94598 Cupertino,CA. 95014
CONTACT:Diana TEL# 925-937-4378
MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER
Febco 805YB DC 3/4" H000624
NEW INSTALLATION: REPLACEMENT:❑
REPLACEMENT DEVICE INFORMATION
MANUFACTURER , MODEL NUMBER TYPE SIZE SERIAL NUMBER
LOCATION OF DEVICESite ID#1004497,Record#5566238364
INTERNAL ❑ METER# 75960691 -
EXTERNAL® TAG#
Hazard Type:Fire Bypass
• REDUCED PRESSURE DEVICES
PRESSURE TYPE Shutoff Valves
DOUBLE CHECK VALVES VACUUM BREAKERS
DIFFERENTIAL
CHECK VALVE CHECK VALVE PRESSURE/RELIEF
AIR INLET CHECK VALVE
NO.1 NO.2 VALVE
CLOSED TIGHT CLOSED TIGHT OPENED AT_LBS. OPENED AT LBS CLOSED TIGHT❑ CLOSED TIGHTS
INITIAL #-Ihs::'�•CJ #lbs. I.& OP #LBS LEAKED
DID NOT DER I.O ❑ ❑
TEST OPENED UNDER 2.0 R DID NOT OPEN❑
LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ LEAKED ❑
REPAIRS
AND
MATERIALS
USED
FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT❑
OPENED AT_#LBS PENED AT_#LB CLOSED TIGHT❑ ❑
TEST #LBS gLBS gLBS
Comments:
THE ABOVE RE 71$CERT I TO PASS
'�VITIAL TEST BV L%�' y CERTIFIED TESTER NO. �Dy(o(rj DATE 3/8/[)-7 FAIL ❑
MO. DAY YR.
REPAIRED BY DATE
PASS ❑
FINAL TEST BY CERTIFIED TESTER NO. DATE FAIL ❑
MO. DAY YR.