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OF 1— INCE USE OQt LY <br />,.Aci, Fee Paid $ <br />dY FA: <br />INSTALLATION CERTIFICATION PR: <br />SR: <br />VGB DRAIN COVER REPLACEMENT Date: <br />NOTE: Use one form for e h pump. <br />For the property named <br />located at 440 c , California, I hereby certify that purs cant to <br />Federal law: Virginia Graeme Baker Pool & Spa Safety Act, that an Anti -entrapment cover meeting the current standards rf the <br />American Society of Mechanical Engineers ASME/ANSI standard A 112.19.8-2007 has been installed per the manufactiv O'S <br />instructions on the: <br />AYl'itOVED BY <br />Er' Swimming Pool <br />❑ Spa Recirculation <br />❑ Spa Jet t Booster DATE: <br />❑ Wadingitoddler pool 11 <br />Existing Pump: Make/Modei N.P if14" Flow (gpm) <br />Cover bears the following markings: <br />Main Drain(s): <br />Manufacturer of approvo cover. <br />Model/Part Number: 9 MIl b"(jJJ r 1 5D6 _ GPM rating: Floor ; Wall_„_,_ <br />❑ "VGB 2008", <br />j-'' "ASME/ANSI standard A 112,19.8-2007", "Life": <br />Equalizer line(s): ((�� <br />Manufacturer of approved cover: Vit 41 ' <br />Model/Part Number: GPM rating: Floor—; Wall, <br />❑ "VGB 2005", - <br />❑ "ASME/ANSI standard A 112.19.8-2007", "Life": <br />Additional information: <br />Main dr in/Jet suction pipe size is inches. Manufacturer's main drain(s) sump depth requirement in inches is: T <br />Single drain <br />C) Dual main drain(s) a <br />Skimmer equalizer line(s) pipe size were found to be _inches # of Skimmers: <br />Manufacturer's skimmer equalizer line(s) sump depth requirement in inches is: <br />[T' Single equalizer line <br />❑ Dual Skimmer equalizer line(s) sump depth inches <br />o Skimmers are connected with single line to pump. <br />C1 Skimmers are separately valved before pump and can be isolated. <br />I declare that I hold an active California State Contractors license # , with the necessary classifications; C• i3, <br />Swimming Pool Builder and/or 0-61ID-35, Swimming Pool & Spa Maintenance & Repair. <br />Signature Print name Date <br />Contact Name: Phone email <br />PAYMENT DUE PRIOR TO APPROVAL CALL PLAN REVIEW AT (916) 8746010 <br />Public Law: 110-140 December 19, 2007 as Printed in the Federal Register <br />(b) DRAIN COVER STANDARD. Effective 1 year after the date of enactment of this title, each swimming Po( r <br />or spa drain cover manufactured, distributed, or entered into commerce In the United States shall conform to <br />the entrapment protection standards of the ASMEIANSI A112.19.8 performance standard, or any successor <br />standard regulating such swimming pool or drain cover. <br />(c) PUBLIC POOLS.— <br />(1) REQUIRED EQUIPMENT.— <br />(A) IN GENERAL.—Beginning 1 year after the date of enactment of this title— <br />(i) Each public pool and spa in the United States shall be equipped with anti -entrapment devices or <br />systems that comply with the ASME/ANSI A112.19.6 performance standard, or any successor standard. <br />Rev. daw 711912008 Z:13 PM <br />