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Backflow Report-2003CROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS 'W'" -"y �`4 BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS * ��j_ INSTALLATION•REPAIRS-TESTING•CERTIFICATION • SiAaarlpy�9ne' BACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.p 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) • - SERVICE ADDRESS MAILING ADDRESS TiShMan SPeyer 3975 Freedom Cir., 1st floor Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE FebDo 825YA RP INTERNAL ❑ TAG EXTERNAL ❑ LOCATION OF DEVICE Blain SEP 2 4 2003 CONTACT TEL# (650) 280-0048 SIZE SERIAL NUMBER 2" BG2012 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS FAIL❑ THE ABOVE REPORT 15 CERTIFIED TO BE TRUE INITIAL TEST BY 1JfA.il7Y ' Y ' ' - " CERTIFIED TESTER NO. 9815 DATE' 9-18-03 MO. DAY YR. 0i REPAIRED BY ... .. _. .. FINAL TEST BY DATE. I ?-'3 ii. CERTIFIED TESTER NO. DATE MO. DAY YR. PRESSLIRE DEVICES .REDUCED PRESSURE TYPE VACUUM BREAKERS'' DOUBLE CHECK VALVES RPP VALVES DIFFERENTIAL CHECKVALVE CHECKVALVE PRESSURE I RELIEF VALVE AIR INLET CHECK VALVE N0.7 N0.2 CLOSED TIGHT Lti CLOSED TIGHT OPENED AT L-A LBS. OPENED AT _ LBS CLOSED TIGHT ❑ INITIAL 0Ib.. % ' q I- 0Iba. OLBS 0 LBS. TEST OPENED UNDER 2.0" OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED Cl REPAIRS AND MATERIALS - USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT Cl OPENED A7 OPENED AT TEST #LBS ALBS _LBS _LBS $LBS THE ABOVE REPORT 15 CERTIFIED TO BE TRUE INITIAL TEST BY 1JfA.il7Y ' Y ' ' - " CERTIFIED TESTER NO. 9815 DATE' 9-18-03 MO. DAY YR. 0i REPAIRED BY ... .. _. .. FINAL TEST BY DATE. I ?-'3 ii. CERTIFIED TESTER NO. DATE MO. DAY YR. 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 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 1522-A DAY AVE., SAN MATEO CA 94403 SERVICE ADDRESS MAILING ADDRESS Tishman 3975 Freedom Cir., 1st floor Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE Watts 909 RP INTERNAL ® TAG EXTERNAL Cl CALIFORNIA (800) (408) 269-2600 FAX (408) 269-2650 LOCATION OF DEVICE irrigation CONTACT AnthOnY TEL# (650) 280.0048 SIZE SERIAL NUMBER 11/2" 175087 IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASTA FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY /7JIAlV►' 8 ' " CERTIFIED TESTER NO. 9815 DATE 9-18-03 . REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. MO. DAY YR, REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF VALVE AIR INLET CHECK VALVE NO.i N0.2 CLOSED TIGHT, �[ CLOSED TIGHT �jl � l,/ OPENEDATAI I LBS. OPENEDAT__LBS CLOSED TIGHT ❑ INITIAL alba. m•L albs, r` #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 #LBB THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY /7JIAlV►' 8 ' " CERTIFIED TESTER NO. 9815 DATE 9-18-03 . REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE MO. DAY YR. 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-FLIMSEP "—. T 3750-E CHARTER PARK DR., SAN JOSE CA 95136.1356 (406) 269-2600 z - E 1522-A DAY AVE., SAN MATEO CA 94403 FAX (408) 269-2650 n 4=903 • SERVICE ADDRESS IuLui 1OFrutkVc.,k-uPcrUUO MAILING ADDRESS Tishman Speyer Properties CONTACT AndlOnY 3975 Freedom Cir., 1st floor TEL# (650) 280-0015 Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Willdns 975XL RP 3/4" 499202&1 la5*7D zre INTERNAL ® TAG ' LOCATION OF DEVICE boilerroomroof EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY 4A J , 1 aAJIL, CI CERTIFIED TESTER NO. 9815 DATE 9-18-03 MO. DAY YR. •REPAIRED BY FINAL TEST BY lsua CERTIFIED TESTER NO. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECKVALVE CHECK VALVE PRESSURE/RELIEF VALVE AIR INLET CHECK VALVE NOA NO.2 CLO ED TIGHT �( CLOSED TIGHT 1� OPENED AT JPLBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL # Ihs. # Ibs. % #LBS # 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 ❑ CLOSED TIGHT Cl #LBS #LBS OPENEDAT_LBS OPENED AT LBS _ #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY 4A J , 1 aAJIL, CI CERTIFIED TESTER NO. 9815 DATE 9-18-03 MO. DAY YR. •REPAIRED BY FINAL TEST BY lsua CERTIFIED TESTER NO. DATE MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS _ INSTALLATION -REPAIRS -TESTING -CERTIFICATION • SAS y qse 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 Speyer Properties 3975 Freedom Cir., 1st floor Santa Clara, CA 95054 MANUFACTURER MODEL NUMBER TYPE Wilkins 975XLSE RP INTERNAL ® TAG EXTERNAL ❑ CALIFORNIA ( (408) 269-2600 FAX (408) 269 - CONTACT Anthony I TEL# (650) 280-0048 LOCATION OF DEVICE cooling tower roof SIZE SERIAL NUMBER 3/4" 1236914 IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASS,fy FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY IVJ�w" ' ` ' / oaCERTIFIED TESTER NO. 9815 • REPAIRED BY FINAL TEST BY DATE C�7437fyL#�Yf�-II4:7T7 DATE 9-18-03 MO, DAY YR. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECK VALVE PRESSURE I RELIEF VALVE AIR INLET CHECK VALVE N0.1 N0.2 CLO DTIGHT CLOSED TIGHT OPENED AT LBS. OPENED AT_LES CLOSEDTIGHT 13INITIAL # Ibe. � # 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 11TEST OPENED AT #LBS #LBS _LBS7OPENED _LBS #LB9 THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY IVJ�w" ' ` ' / oaCERTIFIED TESTER NO. 9815 • REPAIRED BY FINAL TEST BY DATE C�7437fyL#�Yf�-II4:7T7 DATE 9-18-03 MO, DAY YR. DATE MO. DAY YR.