BACKFLOW PREVENTION CERTIFICATION OF RE-CLAIMED WATER SYSTEMS CROSS CONNECTION SPECIALISTS
! BACKFLOW PREVENTION VALVE EXPERT
CERTIFIED CROSS CONNECTION CONTROL CONSULTANTS �} INSTALLATION-REPAIRS-TESTING-CERTIFICATION
%ACKFLOW ,PREVENTION :.SPE.CIALISTS, INC.
'LICENSED CONTRACTORC.C.L.#427328 CALIFORNIA (800)464-FLOW(3589)
.3750-E CHARTER PARK DR::SAN'JOSE CA 95136-1358 (408)289-2800
1522-A DAY AVE.,SAN MATEO CA 94403 FAX(408)269-2650
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SERVICE ADDRESS TF113ILT-W Cupertino near Wolfe
MAILING ADDRESS M&B Plumbing CONTACT David
1440 S.Main St TEL# 262-4800
Milpitas,CA 95035
MANUFACTURER MODEL NUMBER TYPE SIZE SERIAL NUMBER
Watts 009 RP 3" 18006
INTERNAL ❑ TAG LOCATION OF DEVICE mtr# 1596844 domestic main
EXTERNAL
IF DEVICE IS ANEW INSTALLATION PLEASE CHECK THIS BO C& PAS FAIL❑
REDUCED PRESSURE DEVICES
_ ... _.- is .. .,...,....._.PR ..
. . . .. ESSURE
TYPE
.. ..... .. . .. .:..
• '�� I DOUBLE CHECK VALVES VACUUM BR
FAKERS'
RPP VALVES DIFFERENTIAL
• CHECK VALVE CHECK VALVE PRESSURE/RELIEF
VALVE AIR INLET CHECK VALVE
N0.1 N0.2 '
t _ .
CLO ,DTIGHT CLOSED TIGHT OPENED AT�LBS. OPENED AT_LBS CLOSEDTIGHT ❑
INITIAL #Ibs. ! U. // #Ibs. #LBS CUBS.
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 I CLBS OPENED AT_LBS OPENED AT_LBS
tLBS
THE ABOVE REPORT IS CERTIFIED TO BE TRUE "
INITIAL TEST BY.(--a CERTIFIED TESTER ,
.. _ �i .
.:..7.C:;... 1
I
- ` � NO.48 DATE 1U-10-02 '
MO. DAY YR.
• REPAIRED BY _ a :'EA.. i..> DATE A
FINAL TEST BY CERTIFIED TESTER NO. DATE
MO. DAY YR.