Loading...
NO PERMIT NUMBER CERTIFICATION OF RECLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS _,, INSTALLATION-i2EPAIRS-TESTINGCERTIFICATION SF,aetdlW 9M' %ACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.LA 427328 CALIFORNIA (8 p4 'F'L�W7 589) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136.1356 (408)269.2600 I d' '" 'Y_ JTM 3808 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-26.O AlIr n SERVICE ADDRESS Stevens Creek Blvd.&Vallco Park,Cu rtino/X-off of Wolfe Rd. MAILING ADDRESS J.Flores Construction Co. CONTACT Joe 4229 Mission St. TEL# (415)337-2934 San Francisco,CA 94112 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Ames 3000SS 10„ 1398210/03 INTERNAL ❑yB TAG LOCATION OF DEVICE �1������#Nl EXTERNAL }� - IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX® PASS FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF N0.1 N0.2 VALVE AIR INLET CHECKVALVE CLOSED TIGHT CLOSED TIGHT OPENEDAT_LBS, OPENEDAT_LBS CLOSED TIGHT E)INITIAL t IEs. 0 Wn s.� #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 LOS CLOSED TIGHT❑ TEST #LBS #LOS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10220 DATE 8-03-05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS tsu�KO1 CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING•CERTIFICATION 10 BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328CALIFORNIA-(8(1,0). W(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136.1356 '""'(408)269=2S?ro � L' 3608 FERNWOOD ST.,SAN MATEO CA 903 I = FAX(408)269- 44 2850 AUG I SERVICE ADDRESS Stevens Creek Blvd.&Vallco Park,Cu rtino/X-off of Wolfe Rd. MAILING ADDRESS J.Flores Construction Co. CONTACT 4229 Mission St. TEL# (415)337-2934 San Francisco,CA 94112 MANUFACTURER MODELNUMBER TYPE SIZE SERIAL NUMBER Ames 4000SS 6° 113483110 INTERNAL ❑,,O TAG LOCATION OFDEVICE mffr nn 6TEvehS 6Yeo EXTERNAL IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOXO PASS FAIL❑ • REDUCED PRESSURE DEVICES ff77 PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECKVALVE CHECKVALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIRINLET CHECKVALVE CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENED AT_LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL i IN, #Ibe. #LBS #LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 N QLEEAKKED I� LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS p " o w9bo0 ANDf-Of �J�� I�/ MATERIALS Y'W� C�&V s USED ���"//s'�y7// FINAL CLOSED TIGHT CLOSEDTIGHT OPENED AT V LBS OPENED AT_LBS CLOSED TIGHT 13 TEBT #LBS� #LBS VVVV #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST B rr CERTIFIED TESTER NO. 10220 DATE 8.03-05 MO. DAY YR. • REPAIRED BY FINAL TEST BY�&il- f CERTIFIED=TESTEER NFO, DATE MO. AY YR. TS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS Q -, tit CROSS CONNECTION CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTIOONN VALVE ALVE EEXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION • S9se• BACKFLOW PREVENTION SPECIALISTS 1. _ C, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800�64FLOW'(356fJD 3750-E CHARTER PARK DR.,SAN JOSE CA 95136.1356 (408)269-2660 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650 U G 1 8 2005 SERVICE ADDRESS Stevens Creek Blvd.&Vallco Park,Cuper ino/X-off of Wolfe Rd. y' MAILING ADDRESS J.Flores Construction Co. CONTACT Joe 4229 Mission St. TEL# (415)337-2934 San Francisco,CA 94112 MANUFACTURER MODEL NUMBER TYPE - - SIZE SERIAL NUMBER Febco 860 RP 2° H09706 INTERNAL ❑ TAG LO/CATION OF DEVICE & y etfr- oh jrerO.'' oUIKj jn&Zr1l- Y (I FJS EXTERNAL %0. IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS Box19 PASS FAILO • 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 CHECKVALVE CLOSED TIGHT CLOSED TIGHT OPENED ATLL LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL #Ibs. Q.6 •Iba. *LBS B 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 ❑ OPENED AT_LBS OPENED AT_LBS CLOSED TIGHT❑ TEST RLBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO. 10220 DATE 8-03-05 MO. DAY YR. . REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR.