TL Contract Data Requirements List A022 Backflow Prev Sys Rpt Samplev2

CDRL A022 Backflow Prevention Systems Report Apr - Jun 202X SAMPLE TEST MONTHS: ZONE 1-Sept/Mar; ZONE 2-Oct/Apr; ZONE 3-Nov/May; ZONE 4-Jun/Dec; ZONE 5-Jan/Jul; ZONE 6-Feb/Aug; ZONE 7-Mar/Sep A

B

D

E

F

ZONE

BLDG

EQUIPMENT ID NO.

MFR

MODEL

G

H

I

J

SERIAL

NUMBER

SIZE

LOCATION

HAZARD

TYPE

N2301120946
H42837
J001590

3"
3/4"
3/4"

Bottom of the Hill on right side of road
Mechanical Room - Chiller Make-Up Water
Boiler Room - Make-Up Water

J013765

3/4"

L

K

N

O

LAST TEST

DATE

Pass/Fail

NEXT

TEST

September
September
September

3/20/2026
3/20/2026

P
P

9/30/2026
9/30/2026

3/20/2026

P

9/30/2026

Mechanical Room - Chiller Make-Up Water
High
March

BACKFLOW DEVICES LOCATED AT VAFB

September

3/20/2026

P

9/30/2026

10/24/2025

P

9/30/2026

Annual Test Schedule

M

P

Comments

BACKFLOW DEVICES LOCATED AT PILLAR POINT

1-01-001-RP
10-01-001-RP
13-01-001-RP

Febco
Febco
Febco

13-01-002-RP

Febco

75-01-001-DC

825Y
LF
825Y
825Y

High
High
High

March
March
March

75-001

3/4"

North end of Bldg.-AHU room Make-up to humidifiers

Low

September

75-01-001-RP

Wilkins
975XL
DC
Febco RP 825Y

H37315

3/4 "

South - Boiler room Heating make-up water

High

September

75-01-002-RP

Febco RP

825Y

H05458

1"

Mechanical room chiller water make-up

High

175-01-001-RP

Watts

009QT

475378

1/2"

Make-Up water closed loop heating system-Mech Rm

High

178-01-001-RP

Watts

1/2"

Make-Up water closed loop heating system-Mech Rm

High

475-00-001-RP

Wilkins

LF009Q
T
975XL

37947

2860560

3/4"

High

475-00-003-RP

Febco

3078

J004799

3/4"

475-01-002-RP

Febco

825Y

A054475

3/4"

Outside - Chiller Water Make Up - North side of
facility
Outside - Chiller Water Make Up - North side of
facility
Boiler Room - Boiler make up water

High

500-01-001-RP

Febco

825Y

J001047

3/4"

A/H Mechanical Room - Chilled Water make-up

High

March
March
March
March
March

September
September
September
September

3/25/2026

P

9/30/2026

3/25/2026

P

9/30/2026

3/10/2026

F

9/30/2026

3/10/2026

P

9/30/2026

3/10/2026

P

9/30/2026

3/10/2026

P

9/30/2026

3/10/2026

P

SAMPLE

High

510-01-001-RP

Febco

825Y

H20445

3/4"

Mechanical room - Make- up chilled water

High

525-01-001-RP

Febco

825Y

J012067

2"

Bottom Interior Protection Inside Southwest wall

High

525-01-002-RP

Watts

957QT

LH-2077

3"

Top Interior Protection Inside Southwest wall

High

730-00-001-DC

Watts

109699

6"

Fire Suppression System-Outside West End

Low

March

March

March

March

March

March

September

September

September

September

September

September

3/28/2026

730-00-002-DC

Watts

730-01-001-RP

Wilkins

975 XL3

20400