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APPROVED BV <br />DATE: <br />INSTALLATION CERTIFICATION <br />VGB DRAIN COVER & SECONDARY DEVICE <br />, California, I hereby certify that pursuant to California <br />State Health & Safety Code Sec. 116064.1 and 116084.2, that an Anti-entrapment cover meeting the current standards of the Amencan Society <br />of Mechanical Engineers (ASME)/ANSI performance standard and where required, a secondary safety device meeting the current ASME/ANSI or ASTM performance standards have been Installed per the manufacturer's instructions on the: <br />74 Swimming Pool rrOekt ri Spa Recirculation D Spa Jet I Rooster CD Wading/toddler pool <br />Existing Pump(s): Make/Model 14 1‘11 w ot ril F.S oo H.P_ le „5// ; Flow (gpm) / 4 <br />Make/Model H.P ; Flow (gprn) <br />located at0740 <br />NOTE. Use one to for e oh pump, r multiple pump tender the same cover. <br />For the property named V i I MO 91 lp , Lti4aux <br />Cover bears the following markings: <br />"VGB 2008 or late, <br />C "ASME/ANSI standard A 112.19.8-2007 or later", 'Life": Main drain/Jet suction pipe size is II 5 inches. Manufacturers main drain(s) sump depth requirement in inches is: 1-5/ cg <br />Single drain - Not unblockable (one of the following secondary devices required: SVRS / Suction limiting vent / gravity drainage / auto pump shut-off/ other approved by enforcement agency) <br />Type of secondary device installed: <br />Manufacturer of approved device: cill1/471 <br />SVRS beers the following markings: Model/Part Number: S P-S00 <br />0 "ASTM F2387", <br />"ASMFANSI standard A 112.19.17-, <br />NOTE; If installing a variable speed SVRS pump a RPM/Time Data sheet shall be faxed to EMO at 8754513 following <br />the installation. (A sample form is available from the Environmental Health Plan Review office) :=Pf-,-Erinilte drain - Unblockable (size and shape that a human body cannot sufficiently block to create a suction entrapment) 0 --teal grin drain(s) <br />Eauall.U tJj <br />Martina ' .aralbproved cover: pt, roc ount <br />Model/p5 5 A-6 GPM rating Floor ZOO Wall (fD Installed on otiVVall o Floor <br />EJANSI standard A 112.19.8-2007 or later", <br />008 or later', <br />"Life": <br />Skimmer equalizer line(s) pipe size were found to be Is inches # of Skimmers: <br />Manufacturers skimmer equalizer line(s) sump depth requirement in Inches is: <br />C Single equalizer line <br />Dual Skimmer equalizer iine(s) sump depth inches )D Skimmers are conneclecl with single line to pump. <br />in Skimmers are separately valved before pump and can be isolated. <br />4.11M, <br />0 I declare that I hold an active California State Contractor license # 75-0_12/ or California State Professional Engineer license with qualified experience working on public swimming pools and that the Information provided above is true to the best <br />of my knowledge. I'm aware that improper certitcation of the above Information shall be subject to potential disciplinary action at the dis n of the licensing authority. <br />Prinii <br />ai <br />4me <br /> <br />'1)ait? <br />act Name Phone 90 '-cW--id.j_i_emallfratit (e.A t, <br />PAYMENT DUE PRIOR TO APPROVAL CALL PLAN REVIEW AT (916) 8744010 <br />For a complete text Of the law, visit. <br />http://irvfo.sen,camovioubj09 -10/bityasmtab 1001-d. df <br />GT/St 39toel AVE( NDSCrik <br />6/s:ased <br />LI02.81A7602T:0 1 <br /> <br />OVITL9S918 <br /> <br />0eITL9S9I6:w 0 JJ 2e:OT ITI212-171D-Ntif <br />OFFICE US P ONLY <br />Fee Paid $ <br />FA: <br />PR: <br />SR: <br />Oaie: <br />40, <br />Main Drainis): <br />Manufacturer of approveo cover. &test MO 114 r <br />Model/Part Number. p)( GPM rating: Floor 20c ; Wall/ Q 0 Instated on o Wall 4/Floor <br />lure