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Backflow Report-2005CERTIFICATION 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 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 1522-A DAY AVE.. SAN MATEO CA 94403 SERVICE ADDRESS 10201 Torre MAILING ADDRESS Tishman CALIFORNIA (800) 464 -FLOW (3569) (408) 269.2600 1-, FAX (406) 269.2650 Anthony 3975 Freedom Cir., 1st floor TEL# 1650) 280-0015 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XL RP 314„ 1237026 INTERNAL ® TAG LOCATION OF DEVICE boiler room roof EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PAS 5w FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY� CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE I RELIEF VALVE AIR INLET CHECK VALVE N0.1 N0.2 CLOSED TIGHT CLOSEDTIGHT OPENEDA - LBS. OPENEDAT-LBS CLOSEDTIGHT ❑ INITIAL Ch. (2_ # IW. �, *LBS A 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 #LSS #LBS OPENED AT_LBS OPENED AT__LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY� CERTIFIED TESTER NO. 10220 DATE 9-08-05 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 CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION BACKFLOW PREVENTIQNISPE IALISTS, INC, LICENSED CONTRACTOR C.C.L.# 427328 +'� c� 20CALIFOR IA (800) 464 -FLOW (3569) 3750-E CHARTER PARK DR., SAN JOSE CA 95136.1356 Sip 2 (408) 269. 800 1522-A DAY AVE.. SAN MATEO CA 94403 FAX (408) 69-2650 SERVICE ADDRESS 10201 Torre Ave., Cupertino REDUCED PRESSURE DEVICES MAILING ADDRESS Tishman Speyer Properties CONTACT Anthony 3975 Freedom Cir., 1st floor TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XLSE RP 3/4" 1236914 • INTERNAL ® TAG LOCATION OF DEVICE cooling tower roof EXTERNAL ❑ IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE ' INITIAL TEST BY CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. • REPAIRED BY FINAL TEST BY a DATE CERTIFIED TESTER NO. DATE MO. DAY YR. 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 CLOSE CLOSEDTIGHT,I OPENEDAT "-LBS. OPENEDAT—LBS CLOSED TIGHT ❑ INITIAL 81bs. 81bs. OLBS - 8 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 CLOSED TIGHT ElCLOSED TIGHT ❑ CLOSED TIGHTBLBS 7T,n$T BLBS OPENED AT,_ LBS OPENED AT LBS 8LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE ' INITIAL TEST BY CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. • REPAIRED BY FINAL TEST BY a DATE CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS �. �we4(gW 9,b• BACKFLOW PREVENTIJ `N Is LICENSED CONTRACTOR C.C.L.#.427328 SEP 2 2 3750•E CHARTER PARK DR., SAN JOSE CA 95136.1356 1522-A DAY AVE., SAN MATEO CA 94403 SERVICE ADDRESS 10201 Toree Ave., Cupertino CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION ►LISTS, INC. (800) 464 -FLOW (3669) MAILING ADDRESS Tishman Speyer CONTACT Anthony 3975 Freedom Cir., 1st floor TEL# (650) 280-0048 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 909 RP 11/2" 175087 INTERNAL ® TAG __. _._. LOCATION OF DEVICE EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX C3 PAS49FAIL❑ THE ABOVE REPORT IB CERTIFIED TO BE TRUE INITIAL TEST BY`7!//. • REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. lw) iW CERTIFIED TESTER NO. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE _ PRESSURE I RELIEF VALVE AIR INLET CHECK VALVE NO.1 NO.2 �—.&— CLOSED TIGHT CLOSED TIGHT /,[}'\ OPENED A LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL t lbs. � # lbs. #LBS C 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 /LBS THE ABOVE REPORT IB CERTIFIED TO BE TRUE INITIAL TEST BY`7!//. • REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. lw) iW CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS �Ari6r'�' CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT INSTALLATION -REPAIRS -TESTING -CERTIFICATION S/aewlha�'1�6.' BACKFLOW PREVENT_I.ONTSPE. IALISTS, INC. LICENSED CONTRACTOR C.C.L.# 427328 I ���� 7d-SP bAL�IFNIA (800) 464 -FLOW (3569) 2600 1522-A DAY AVER SAN MATEO CA 94403 PARK DR., SAN JOSE A 95138.1358 SEP 2 2 2( VAX)(40 ) 269-2650 • SERVICE ADDRESS 10201 Toree Ave., Cupertino �= MAILING ADDRESS Tishman Speyer 3975 Freedom Cir., Ist floor Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE Febco 825YA RP INTERNAL ❑ TAG LOCATION OF DEVICE main EXTERNAL CONTACT Anthony TEL# (650)280-0048 SIZE SERIAL NUMBER 2" BG2012 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS;V FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY - CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURETYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF VALVE AIR INLET CHECKVALVE N0.1 N0.2 CLOSEDTIGHT,W CLOSEDTIGHT V OPENEDATSQ LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL # Ibo. It tbs. #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 #LBS #LBS OPENED AT _LBS OPENED AT _LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY - CERTIFIED TESTER NO. 10220 DATE 9-08-05 MO. DAY YR. • REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR.