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BACKFLOW CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS INSTALLATION-REPAIRS-TESTING-CERTIFICATION SMvsluts,9M' %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)269-26 -7'r..1 Tj�r � SERVICE ADDRESS 10600 Rid eview CL,Cu rtin0/X-Stevens Creek JAN 2 ® 2004 MAILING ADDRESS Tech Facility Siemens Bldg attn: Accounts Payable CONTACT Dave BY: — - 801 Asbury Dr TEL# 773-6220 Buffalo Gmve,IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Watts 709 DC 3/4" 59558 INTERNAL ® TAG LOCATION OF DEVICE bDllerbldg 13 EXTERNAL ❑ IF DEVICE IS A NEW INSTALLATION PLEASE CHECK THIS BOX❑ PASOO FAILO • 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 CLOSED`TTIIGH CLOSED TIGHT OPENEDAT_LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL # be. #lbs. Z •d #LBS #LBS, TEST OPENED UNDER 2.0 OPENED UNDER 1.0 LEAKED ❑ LEAKED ❑ OR DID NOT OPEN ❑ OR OIO NOT OPEN ❑ LEAKED ❑ REPAIRS AND MATERIALS USED FINAL CLOSED TIGHT❑ CLOSED TIGHT ❑ OPENEDAT_LBS OPENED AT LES CLOSED TIGHT TEST #LBS #LBS 1 LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE //l�'7/�-� _ INITIAL TEST BY TIFIED TESTER N0. 2656 DATE 12-10-03 MO. DAY YR. • REPAIRED BY DATE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. CROSS CONNECTION SPECIALISTS CERTIFICATION OF RE-CLAIMED WATER SYSTEMS "_ .��4 BACKFLOW PREVENTION VALVE EXPERT CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS .��) INSTALLATION-REPAIRS-TESTING-CERTIFICATION s�uaw'/��.d• %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 FAX 269-2669-2850 00 1572-A DAY AVE.,SAN MATEO CA 94403 i's h',r'*'K., ¶'L•J'M•T"�, I., qq SERVICE ADDRESS 10600 Ridgeyiew CLN ,Cupertino/X-Stevens Creek I JAN 0 2004 MAILING ADDRESS Tech Facility Siemens Bldg attn: Accounts Payable CONTACT Dave r4*y' 801 Asbury Dr TEL# 773-6220 Buffalo Grove,IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Febco 805 DC 11/2" 15138 INTERNAL ® TAG LOCATION OF DEVICE cooling tower bldg 13 EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX❑ PASS91 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 OPENED AT_LBS, OPENED AT_LBS CLOSEDTIGHT ❑ INITIAL p tbs. 7i ' p tbs. Z ALBS p 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 Cl CLOSED TIGHT ❑ CLOSED TIGHT❑ TESTpLBS pLBS OPENED AT_LBS OPENED AT_LBS I LBS THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST BY ERTIFIED TESTER N0, 2656 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 CONSULTANTS BACKFLOW PREVENTION VALVE EXPERT� INSTALLATION-REPAIRS-TESTING-CERTIFICATION 3 �grs• *BACKFLOW PREVENTION SPECIALISTS, INC, LICENSED CONTRACTOR C.C.L.#427328 CALIFORNIA (800)464-FLOW(3569) 408 269-2600 „�„�,_ 3750-E CHARTER PARK DR.,SAN JOSE CA 95136-1358 FAX 408 269-265077' 1 C'R'py!�7 n 1522-A DAV AVE.,SAN MATED CA 94403 ( ) SERVICE ADDRESS 10600 Rid eview Q.,Cu rtino/X-Stevens Creek i JAN 2 0 2004 MAILING ADDRESS Tech Facility Siemens Bldg atin:Accounts Payable CONTACT Dave ' 801 Asbury Dr TEL# 773-6220 Buffalo Grove,IL 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Wilkins 975XL RP 11/2" 1164381 INTERNAL ® TAG LOCATION OF DEVICE cooling tower building 13 EXTERNAL ❑ IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BOX[3 PASS& 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 CHECKVALVE CLOS TIGH ,a CLOSEDTIGHT,,� OPENED AT3 ALBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL albs. 0tbs. #LBS #LSE. 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 ItLas ALBS OPENED AT_LBS OPENED AT LEE It 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 DOTE FINAL TEST BY CERTIFIED TESTER NO. DATE MO. DAY YR. Ir^ CERTIFICATION OF RE-CLAIMED WATER SYSTEMS V CROSS CONNECTION SPECIALISTS /;.(6 ;., 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)268-2600 1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650 SERVICE ADDRESS 1060ORidgeview Ct.,Cuperlino/X-Stevens Creek I IAKI o „ ^ MAILING ADDRESS Tech Facility Siemens Bldg attn: Accounts Payable CONTACT Dave 801 Asbury Dr TEL# 773-6220 Buffalo Grove,M 60089 MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER Feboo 825YA' RP 2° A003988 INTERNAL ❑ TAG LOCATION OF DEVICE irrigation bldg meter next to bldg 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 OPENEOATE_f LBS. OPENEDAT_LBS CLOSED TIGHT ❑ INITIAL albs. 70 #lbs. #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 Cl TEST #LBS #LBS OPENED AT_LBS OPENED AT_LBS 7 LBS THE ABOVE REPORT IS CERTIFIED TOBETRUE INITIAL TEST BY CERTIFIED TESTER NO.2656 DATE 12-10.03 MO. DAY YR. •REPAIRED BY DATE x,15 FINAL TEST BY CERTIFIED TESTER NO. DATE MO.`,._DAY YR. . r