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BACKFLOWCERTIFICATION OF RE-CLAIMED WATER SYSTEMSCROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS Y • BACKFLOW PREVENTION VALVE EXPERT INSTALLATION-REPAIRS-TESTING-CERTIFICATION S qre• ' BACKFLOW PREVENTION SPECIALISTS, INC. LICENSED CONTRACTOR C.C.L.# 427326 CALIFORNIA (800) 464 -FLOW (3569) 3750-E CHARTER PARK DR., SAN JOSE CA 95136-1356 (408) 269-2600 _ 3606 FERNWOOD ST., SAN MATEO CA 94403 _ _ FAX (408) 269-2650 SERVICE ADDRESS vaucO rarKway & orevens LdeeK, cupenmo MAILING ADDRESS Tech Facility Siemens Bldg attn: Accounts Payable 801 Asbury Dr Buffalo Grove, IL 60089 CONTACT .Uave TEL# 773-6220 JAN 2 0 2004 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 909 RP 3" 121167 INTERNAL ❑ TAG LOCATION OF DEVICE lc_c:! RPP VALVES EXTERNAL ❑ �7�e w( r• 1 5 CHECKVALVE IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASS❑ FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY 0 - REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO, 2656 DATE 12-10-03 MO. DAY YR. DATE i CERTIFIED TESTER NO. DATE�� MO. DAY YR. J REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE/RELIEF NO.1 N0.2 VALVE AIR INLET CHECK VALVE CLOSED TIGHT ❑ CLOSED TIGHT ❑ OPENEDAT_LBS. OPENEDAT_LBS CLOSEDTIGHT ❑ INITIAL III lbs, 0Ibs. #LBS #LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED Cl LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT ❑ TEST ALBS ALBS OPENED AT_LBS OPENED AT_LBS I LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY 0 - REPAIRED BY FINAL TEST BY CERTIFIED TESTER NO, 2656 DATE 12-10-03 MO. DAY YR. DATE i CERTIFIED TESTER NO. DATE�� MO. DAY YR. J CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS _C' BACKFLOW PREVENTION VALVE EXPERT �j 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 3608 FERNWOOD ST., SAN MATEO CA 94403 FAX (408) 269-2650 • SERVICE ADDRESS Vallco Parkway & Stevens Creek, Cupertino MAILING ADDRESS Trammell Crow CONTACT Gene 10555 Ridgeview Ct TEL# 623-0045 Cupertino, CA 95014CA 95014 MANUFACTURER MODEL NUMBER TYPE SIZE_ SERIAL NUMBER Febcw 825 RP 3„ 9509051346 INTERNAL .R TAG LOCATION OF DEVICE behind fence end of lot G EXTERNAL ❑ f�llAA, IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX El PASS Ip FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TESTS CERTIFIED TESTER NO, 48 DATE 1-06-03 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 CHECK VALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE TIGHT CLOSED T tS;TI CLOSED TIGHT T OPENED AT!2 —LBS. OPENED AT LBS CLOSED TIGHT ❑ INITIAL # Ibs. # 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 El TEST #LBS #LBS OPENED AT _LBS OPENED AT _LBS $LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TESTS CERTIFIED TESTER NO, 48 DATE 1-06-03 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 BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS -. . INSTALLATION -REPAIRS -TESTING -CERTIFICATION JBACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.# 427328 CALIFORNIA (800) 464 -FLOW (3589) 3750-E CHARTER PARK DR., SAN JOSE CA 95136.1356 (408) 269-2600 1522-A DAY AVE., SAN MATEO CA 94103 FAX (408) 269-2650 SERVICE ADDRESS Vallco Parkway & Stevens Creek, Cupertino MAILING ADDRESS Compaq COmputerfrmmmell Crow CONTACT anC 10555 Ridheview Ct Cupertino, CA 95014 MANUFACTURER MODELNUMBER TYPE 909 0 TEL# 623-0045 SIZE SERIAL NUMBER 4" 166966 INTERNAL Cl TAG LOCATION OF DEVICE F✓S Tantau 75'N. of Vallco Parkway EXTERNAL 0% ylggg `P 1 O A t✓ IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX El PASS -1 FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST B CERTIFIED TESTER NO. 48 . REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE 1-06-03 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 N0.1���� N0.2 VALVE AIR INLET CHECK VALVE CLOSE�DTH.YLW CLOSED TIGHT.� OPENED AT LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL #lbs. ffoo #lbs. #LBS #LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR DID NOT OPEN Cl LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT ❑ CLOSED TIGHT ❑ CLOSED TIGHT Cl TEST NUBS #LBS OPENED AT_LBS OPENED AT_LOS OEM— THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST B CERTIFIED TESTER NO. 48 . REPAIRED BY FINAL TEST BY DATE CERTIFIED TESTER NO. DATE 1-06-03 DATE MO. DAY YR. MO. DAY YR. CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS CERTIFIED CROSS CONNECTION CONTROL CONSULTANTSBACKFLOW PREVENTION VALVE EXPERT " INSTALLATION -REPAIRS -TESTING -CERTIFICATION 0 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 3608 FERNWOOD ST., SAN MATEO CA 94403 FAX (408) 269-2650 SERVICE ADDRESS Vallco Parkway & Stevens Ctcek,Sh:yCns Cupertino -- MAILING ADDRESS TiaIDmell Crow 10555 Ridgeview Cl Cupertino, CA 95014CA 95014 MANUFACTURER MODELNUMBER TYPE Febco INTERNAL ❑ TAG EXTERNAL 805 LIQ CONTACT GenC TEL# 623-0045 SIZE SERIAL NUMBER 4" 6232 LOCATION OF DEVICE 2nd vault right of driveway IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX C3 PASS 9r FAIL❑ THE ABOVE REPORT IS CERTIFIED TO BE TRUE / INITIALTES BV CERTIFIED TESTER NO. t�" — . REPAIRED BY FINAL TEST BY } DATE CERTIFIED TESTER NO. DATE 1-06-03 MO. DAY YR. DATE MO. DAY YR. REDUCED PRESSURE DEVICES PRESSURE TYPE DOUBLE CHECK VALVES VACUUM BREAKERS RPP VALVES DIFFERENTIAL CHECK VALVE CHECKVALVE PRESSURE/RELIEF N0.1 N0.2 VALVE AIR INLET CHECK VALVE CLOS DTIGHT b. CLOSED TIGHT 2y OPENEDAT_LBS. OPENED AT_LBS CLOSED TIGHT ❑ INITIAL a Ibs. � a Ibs. 1 4' #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 #LBS ALBS OPENED AT_LBS OPENED AT_LBS t LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE / INITIALTES BV CERTIFIED TESTER NO. t�" — . REPAIRED BY FINAL TEST BY } DATE CERTIFIED TESTER NO. DATE 1-06-03 MO. DAY YR. 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 3608 FERNWOOD ST., SAN MATEO CA 94403 FAX (408) 269-2650 • SERVICE ADDRESS Va11Co Parkway & Stevens Creek, Cupertino MAILING ADDRESS Trammell CLOW 10555 Ridgeview Ct Cupertino, CA 95014CA 95014 MANUFACTURER MODEL NUMBER TYPE Watts 909 RP INTERNAL ❑ TAG LOCATION OF DEVICE EXTERNALi3Ae -- CONTACT Gene TEL# 623-0045 SIZE SERIAL NUMBER 4° 163453 Creek Bldg 15-16 near PIV IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX [3 PASS FAIL❑ �... THE ABOVE REPORT IS CERTIFIED TO BE TRUE { INITIAL TEST BY _ 'i. CERTIFIED TESTER NO. 48 DATE, 1-06-03,",P 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 CHECK VALVE PRESSURE I RELIEF • - N0.1 ' � '- N0.2 • VALVE �' ' .. AIR INLET .. CHECKVALVE CLOSED TI HT , CLOSED TIGHT D34 OPENED AT�` () LBS. OPENED AT _ LBS CLOSED TIGHT C1INITIAL 0Ibs. �, .. #Ibs. #LBS ALBS, 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 C3 CLOSED TIGHT ❑ CLOSED TIGHT El TEST #LBS ALBS OPENEDAT_LBS .OPENED AT _LBS #LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE { INITIAL TEST BY _ 'i. CERTIFIED TESTER NO. 48 DATE, 1-06-03,",P MO. DAY , YR. . REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR.