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Backflow Prevention Specialists _ •� ... f%CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION'SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION OBACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3589) 3750-E CHARTER PARK DR.,SAN JOSE CA 951364358 (408)269-2600 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650r�-,— '_.;".�,�T.� ,r SERVICE ADDRESS 10300 N Tantau Ave.,Cupetlino ` S ® : = 2004 MAILING ADDRESS Tech Facilty Siemens Bldg attn: Accounts Payable CONTACT DaVA - . 801 Asbury Dr TEL# 773-66220 Buffalo Grove,IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 909 RP 3/4" 479788 INTERNAL ® TAG LOCATION OF DEVICE chiHerbldg 5 roof EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSY SS FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF N0.1 NO.T VALVE AIR INLET CHECK VALVE CLOSEDjHT CLOSEDTIGHT� OPENEDAT:7�0LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL #Ibs. #lbs. #LBS #LBS TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN Cl OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ OPENED A7_LBS OPENED AT_LBS CLOSED TIGHT Cl TEST #LBS #LBS FLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO,-2C)56 < Ifs DATE 12-10-03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTSBACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION %ACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650 (.�,3' .,; SERVICE ADDRESS 10300 N Tantau Ave.,CupertinoJ JAN baa, MAILING ADDRESS Tech Facility Siemens Bldg attp}{ n:Accounts Payable CONTACT Dave t.;�}b3, 801 Asbury Dr TEL# 773-6220 Buffalo Grove,IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009 RP V 211644 INTERNAL ® TAG LOCATION OF DEVICE boiler ncedladder bldg5 Ist floor boiler#2 EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASSE] FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE �� CLOSAD T HT El CLOSED TIGHT ❑ OPENED AT;'6 LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL #Ibs. Ibe. #LBS #LBS. TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN Cl OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ OPENED AT_LBS OPENED AT_LBS CLOSED TIGHT❑ TEST #LBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED,T{OO QBE T/RRUUUEEE INITIALTESTBY_ `L.-.J rry`�`rLu.t� CERTIFIED TESTER NO.*265& 9DI� DATE 12-10-03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO, DATE MO. DAY YR. I CERTIFICATION OF RE-CLAIMED WATER SYSTEMS _ '' CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS INSTALLATION-REPAIRS-TESTING-CERTIFICATION • BACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)484-FLOW(3589) 3750-E CHARTER PARK DR.,SAN JOSE CA 95138-1356 (408)269-2600 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650�T��a� SERVICE ADDRESS 10300 N Taritau Ave.,Cupertino ( JAN 2 0 2004 MAILING ADDRESS Tech Facih�Siemens Bldg attn: Accounts Payable attn: Accounts Payable CONTACT Dave by. 801 Asbury Dr TEL# 773-6220 Buffalo Grove, Q,60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009 RP 3/4" N/A INTERNAL ® TAG LOCATION OF DEVICE Bldg 5 roof Cooling tower EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PAS 8 FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECKVALVE CHECKVALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE /� /-� CLOS IGHT CLOSED TIGHT CPENEDATO 'V LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL #Iba. #lbs. 0LB3 #LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED Cl 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 #LBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO�e� C V�s DATE 12-10-03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. y CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTSV BACKFLOW PREVENTION VALVE EXPERT'' INSTALLATION-REPAIRS-TESTING-CERTIFICATION *BACKFLOW. PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)484-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 3608 FERNWOOD ST.,SAN MATEO CA 94403 FAX(408)269-2650 u. SERVICE ADDRESS 10300 N TaNau Ave.,Cupertino ` JAN 2 0 2004 V MAILING ADDRESS Tech Facility Siemens Bldg attn:Accounts Payable CONTACT Dave 801801 Asbury TEL# 773-6220 Buffalo Grove,IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 825YA RP 11/2" A041144 INTERNAL ® TAG LOCATION OF DEVICE Bldg 5 outside by garage entrance on cooling tower EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[] PAS 4_ FAIL❑ • REDUCED PRESSURE DEVICES r PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIG�HT CLOSED TIGHT OPENED ATZ_LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL #lbs, --/ #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 ❑ CLOSED TIGHT❑ TEST OPENED AT_LBS OPENED AT_LBS #LBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER N0. 2656 DATE 12-10.03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE -MO. DAY YR. >t CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION %ACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650 SERVICE ADDRESS 10300 N Tantau Ave.,Cuperfino ' MAILING ADDRESS Tech Facility Siemens Bldg atlas:Accounts Payable CONTACT DaveAN 2 d 2004 801 Asbury Dr TEL# 773 y: — - -- Buffalo Grove,IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009 RP 2" 00699 INTERNAL ❑ TAG LOCATION OF DEVICE by cylone fence bldg 5 EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASSP FAIL❑ . REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT CLOSED TIOHT,�:M' OPENED AT Z'67 LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL #lbs. #lbs. OLDS #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❑ TEST #LBS #LBS OPENED AT_LBS OPENED AT_LBS III LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY - p� CERTIFIED TESTER NO. 2656 DATE 12-10-03 MO. DAY YR. ..REPAIRED BY DOTE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS gg����rr CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS V INSTALLATION-REPAIRS•TESTING-CERTIFICATION �ACKF7 LOW PREVENTION SPECIALISTS INC, LICENSED CONTRACTOR C.O.L.#427328 CALIFORNIA (800)4&r-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136.1356 (408)268-2600 `- 1522-A DAY,AVE.,SAN MATEO CA 94403 FAX(408)269-2650 JAN 2 0 2004 SERVICE ADDRESS 10300 N Tantau Ave.,Cupertino MAILING ADDRESS Tech Facility Bldg Accounts Payable attn:Accounts Payable CONTACT Dave 801 Asbury Dr TEL# 773-6220 Buffalo Grove, IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 909 RP 10" 400604 INTERNAL ❑ TAG LOCATION OF DEVICE fire right of driveway bldg 5 EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSµI FAIL❑ • REDUCED PRESSURE DEVICES //� PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSEDTIGHT CLOSEDTIGHT., � OPENEDAT-'•�LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL 0Ibs. 6.2 9Ibe. #LBS 0 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 0LBS OLOS 0 A THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER N6.2656 DATE 12-10-03 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 3- BACKFLOW PREVENTION VALVE EXPERT . CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS ��) INSTALLATION-REPAIRS-TESTING-CERTIFICATION SMvsC�eW ?+6' %ACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800) F ?,wT 9'�T% 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 T��� 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650 SERVICE ADDRESS 10300 N.Tantau Ave.,Cupertino MAILING ADDRESS Tech Facility Siemens Bldg attn:Accounts Payable CONTACT Dave 801 Asbury Dr TEL# 773-6220 Buffalo Grove, IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 825Y RP 2" T9302 INTERNAL ❑ TAG LOCATION OF DEVICE bldg 5 irrigation EXTERNAL ® meter protection IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASSE`-FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECKVALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT CLOSED TIGHT,45— OPENED ATZ_Z LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL albs. Z' #lbs. #LBS #LBS, TEST OPENED UNDER 2,0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ ry REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ OPENED AT_LBS OPENED AT_LBS CLOSED TIGHT❑ TEST #LBS #LBS 9LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.2656 DATE 12-10-03 MO. DAY YR. • REPAIRED BY DOTE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 (408)269-2600 _ 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650 � � JAN 2 0 2004 SERVICE ADDRESS 10_300 N Tantau Ave.,300 N AveCupertino MAILING ADDRESS Tech Facifi�Siemens Bldg attn: Accounts Payable attn: Accounts Payable CONTACT Dave BX' 801 Asbury Dr TEL# 773-6220 Buffalo Grove,IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 009 RP 3/4" 178022 INTERNAL ® TAG LOCATION OF DEVICE boilerneedladderbldg5 garagebasement EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PAS FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET. CHECK VALVE CLOS�EW TIGHT a CLOSED TIGHT OPENED AT z_� LBS. OPENED AT LBS CLOSED TIGHT ❑ INITIAL #16s. X- #Ihs. #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_LBS CLOSED TIGHT❑ TEST #LBS #LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY CERTIFIED TESTER NO.2656 DATE 12-10-03 MO. DAY YR. • REPAIRED BY [NTE FINAL TEST BY CERTIFIED TESTER NO. DATE l MO. 4 DAV YR. } CERTIFICATION OF RE-CLAIMED WATER SYSTEMS �� �/��ar� CROSS CONNECTION SPECIALISTS; CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS 4f""° BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION BACKFLOW PREVENTION SPECIALNUIS,�IN4. C LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)484-FL,�3569) 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1356 FAX )269-2600 - G 2004 1522-A DAY AVE.,SAN MATEO CA 94403 SERVICE ADDRESS 10300 N Tantau Ave.,Cupertino MAILING ADDRESS Tech Facility Siemens Bldg atm: Accounts Payable CONTACT Dave 801 Asbury Dr TEL# 773-6220 Buffalo Grove, IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Waris 909 RP 10" 400516 INTERNAL ❑ TAG LOCATION OF DEVICE by Cylone fence bldg 5 EXTERNAL IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASO FAIL❑ • REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT CLOSED TIGHT OPENEDAT 2'�LBS. OPENEDAT_LBS CLOSED TIGHT Cl Nibs. �'0 #Ihs. #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 e FINAL CLOSED TIGHT Cl CLOSED TIGHT ❑ OPENED AT_LBS OPENED AT_LBS CLOSED TIGHT Cl TEST #LBS #LBS - tLBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY d CERTIFIED TESTER NO. 2656 DATE 12-10-03 MO. DAY YR. REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR.