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/4 /7'/2 <br />Print name Date installed <br />Signature <br />< ' P.. / <br />Virginia Graeme Baker Certifi,ion <br />For thp_p_Loperty located at <br /> <br />05-0 -CiOc-iSCV7 _C <br />County, California, I hereby certify that pursuant to the Virginia Graeme Baker Pool & <br />Spa Safety Act (Federal Law), that an Anti-entrapment cover meeting the current standards of 'the <br />American Society of Mechanical Engineers ASME/ANSI standard A <br />112_19.8-2007 has been installed per the manufacturer's instructions on the: <br />ra/--S7firnming Pool <br />Spa <br />Wading/toddler pool — <br />Pump: Make/Model <br /> ; Flow <br />Manufacturer of approved cover: <br />Cover bears the following markings: <br /> <br />Model/Part Number:1/Lijyji ,“/_21_2(2. GPM rating: Floor- Wall VGB 2008", <br />"ASME/ANSI standard A 112.19.8-2007", "Life": r <br />Additional information: <br />Main drain/Jet suction pipe size was found to be inches. Cover screws are5-, color. Single drain <br />Dual main drain(s) Main drain(s) sump depth inches Skimmer equalizer line(s) pipe size were found to be inches Single drain <br />Dual Skimmer equalizer line(s) Skimmer equalizer line(s) sump depth inches Skimmers are connected with single line to pump. <br />0 Skimmers are separately valved before pump and can be isolated. <br />I declare that I hold an active California State Contractors license # *05-7 ,with the necessary classifications; C-53, Swimming Pool Builder and/or C-61/D-35, Swimming Pool & Spa Maintenance & Repair. <br />Public Law: 110-140 December 19, 2007 as Printed in the Federal Register <br />DRAIN COVER STANDARD.—Effective 1 year after the date of enactment of this title, each <br />swimming pool or spa drain cover manufactured, distributed, or entered into commerce in the <br />United States shall conform to the entrapment protection standards of the ASME/ANSI <br />A112.19.8 performance standard, or any successor standard regulating such swimming pool or drain cover. <br />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 <br />devices or systems that comply with the ASME/ANSI A112_19.8 performance standard, or any successor standard. <br />NOTE: Use one form for each pump.