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NO PERMIT NUMBER (5) Cal-Air, Inc. 1555 South Seventh St. LAIR' San Jose, CA 95112 Ph. (408) 283.2300 Pax. (408) 293.9511 tkrl)119] BACKFLOW CERTIFICATION SERVICE ADDRESS: 162500 jej*tlltr� (Z ' _ °tPPk a10(9 DEVICE LOCATED: efd9UlCL,.1 /CJ RETURN TO: ACCT NO, METER NO. Mallin Address `� '+k+`2ti359)t E.'OEVICE',­FO ...., '; r ?ar r' '��� INFORMATIO�N�S]r.y,�;?'CLld;.h,��' Type ' Size MFG Model 7tA SER.NOB Jy. TYPE OF SERVICE ❑ DOMESTIC . % IRRIGATION CONTACT: ❑ INDUSTRIAL ❑ FIRE Job Number REPORT OF TEST RESULTS ❑ PASS ❑ FAIL REDUCED REDUCED ASSEMBLY �ChCPRE55URErVA000MBRBAKER�S;�1. ,A,lG DOUBLE CHECK .Air Inlet Check Valve {�tj �1 `ws{�}i } {CHECKVALVE� q° (gC�HECK VAIiVE }v 'rYr " RHLfEFy�rr`I '±•3kE°r`•1`Opened at Closed Tight - w�i><`;i'�r}I✓ gFk'it.vi�(ki"1l1N0.18tI3 &tiN �I.isi�Ii'klN0.2�h)I :'y,-34' � ' !:tIlly i "vnLVE'NI{*I)IIE� hi1 PSID • 'Itl'jq�' nptCLOSED TIGHT CLOSED TIGHT OPENED AT PSID PSID � INIRTItALrl I LEAKED ❑ LEAKED ❑ 8 Opened Under 1.0 PSID yr `IrTE{T " Did Not Open ❑ Leaked ry6 '. PSID ❑ CLOSEDTIGHT a _ ❑ UNDER 2.O PSI �lvll-tau SHUT-0F.F VALVErLu: iln}t� c.� n1X ❑ °�,'i0Pn! , LEAKED ❑ LEAKED ❑ DID NOT OPEN N0.1 N0.2 ='%''114 CLEANED CLEANED CLEANED LEAKED il�VIillqtr , ❑ ❑ ]� dt tiw �rbrvnk.' CLOSED TIGHT RIA, 1t' 'Trf4l REPLACED ❑ REPLACED ❑ REPLACED ❑ "�' `1'- �x ❑ DISC ❑ DISCS ❑ n I ilt;r DISC DISCS) ❑ ❑ CLEANED N ;ih�`111v=�.M ❑ SPRING ❑ SPRING ❑ ' N,'REPAI P SPRING 7-"nt+;;,,,.,4tk`plyl.j GUIDE ❑ GUIDE ❑ DWPHRAGM(S) 11 1-1REPLACED 'r ❑ r§� �'SEAT ❑ SEAT ❑ SEAT(S) ❑ MODULE ❑ MODULE ❑ O•RINGS ❑ Replaced With - ` .p OTHER ❑ OTHER ❑ MODULE ❑ A.r];;iutlffiut,3. OTHER Type ��.FINACt"1`�r" CLOSED TIGHT CLOSED TIGHT OPENED AT a¢n!1+sTE3T '�h"n,5 PSID PSID PSID - Mf Note:Please keep in your files for 3 years, THE ABOVE REPORT IS CERTIFIED TO BE TRUE: REPAIRED BY: d r DATE: FINAL TEST BY: SCOtt B✓1I�$ CERTIFIED TESTER NO. IO(.'Sz— DATE: 3.19,09 COMMENTS: �C9B — .//Y'ry4hnDn Foster City Glendale Los Angeles Sacramento San Francisco Santa Rosa Fresno Liveimoia Orange San Diego San Jose , Salinas Whittier Ontario