Attachment 4 Backflow list.xls

XLS spreadsheet 2 MB Posted Jul 15, 2021

Attached to: Cross Connection Survey - Offutt AFB, Nebraska Federal contract opportunity
Solicitation number: FA460021SS003
Issued by: Department of the Air Force Air Combat Command

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INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

PROGRAM MANAGER

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

Al. Nelson 294-7586 / 4836

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMNT/POLLUTENT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

1 TEST

500 BLDG BOILER RM

H.W. MAKEUP TO 750 TON RACK

CHEMICALS

128893/HIGH

YES

R.P.B.P.

WATTS

909

3/4"

DEVICE DELETED, NO LONGER NEEDED 7/19/04 NELSON

6 TEST

BLDG. 500 BOILER ROOM

GROSS. MAKE UP TO WATER SOFT / BOILER

CHEMICAL

CY112/HIGH

YES

R.P.B.P.

CONBRACO

40207A2

11/2"

Device transferred to 500 Maint

51/001

5TEST

7 TEST

500 BLDG BOILER RM

MAKEUP TO CHILLED H2O SYSTEM

CHEMICALS

89971 /HIGH

YES

R.P.B.P.

WATTS

009-M1

Device transferred to 500 Maint

50/004

11 TEST

BLDG 500BH 30 MECH RM

MAKEUP FOR REHEAT SYS, H-WING

CHEMICALS

89814/HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

Device Removed

7/21/07

50/005

12 TEST

500 BLDG BJ WING-MECH RM

MAKE-UP FOR BOILERS

CHEMICALS

568620/HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device transferred to 500 Maint

50/006

13 TEST

500 BLDG 3J MECH RM

MAKEUP FOR REHEAT SYSTEM

CHEMICALS

116207/HIGH

YES

R.P.B.P.

WATTS

909

Device transferred to 500 Maint

50/007

14 TEST

BLDG 500 KITCHEN

C.W. TO COOKING HOOD SYSTEM

GREASE / CHEMICALS

34080 / HIGH

YES

R.P.B.P.

WATTS

OO9

1 1/4"

Device transferred to 500 Maint

50/376

15 TEST

BLDG 500 RM 1E11

C.W. SUPPLY TO CHEMICAL DISPENSER

SOAP CHEMICALS

A21613 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device transferred to 500 Maint

50/001

16 TEST

BLDG 500 KITCHEN

POP DISPENSERS

CARBONATION, SYRUP

55124/LOW

YES

R.P.B.P.

WATTS

009M2

1/2"

Device transferred to 500 Maint

50/008

17 FP

BLDG 500 THEATER MECH RM

FIRE PROTECT SYSTEM THEATER

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

VIKING

C421-2

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

18 VB

BLDG 500 H WING

11 HOSE BIBBS, 8 SERVICE SINKS, 12 WALL HYDRANTS

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

19 VB

BLDG 500 JWING

4 HOSE BIBS, 4 SERVICE SINKS

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

20 VB

BLDG 500 D WING

2 SERVICE SINKS

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

21 VB

BLDG 500 G WING

4 HOSE BIBS, 4 SERVICE SINKS, 4 WALL HYDR.

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

22 VB

BLDG 500 A WING

6 HOSE BIBBS

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

23 VB

BLDG 500 F WING

6 HOSE BIBBS, 4 SERVICE SINKS

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

24 VB

BLDG 500 B WING

7 HOSE BIBBS, 4 SERVICE SINKS

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

25 VB

BLDG 500 BOILER RM

27 HOSE BIBBS

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

ALL EQUIPMENT DRAINS SHOULD BE LABELED AS NON-POTABLE WATER

26 TEST

BLDG 515 MECH RM

C.W. MAKEUP TO REHEAT SYSTEM

CHEMICALS

HIGH / 115925

YES

R.P.B.P.

WATTS

909

3/4"

Device transferred to 500 Maint

50/009

27 FP

BLDG 515 MECH RM

FIRE PROTECT SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

RELIABLE

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

28 FP

BLDG 515 MECH RM

FIRE PROTECT SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

RELIABLE

29 FP

BLDG 515 MECH RM

FIRE PROTECT SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

RELIABLE

30 FP

BLDG 578 MECH RM

FIRE PROTECT SYSTEM

RUST STAGNANT WATER

LOW/ FO312041310

YES

DCV

FEBCO

850

TESTED DEVICE 6/26/13 Alves

0/26/2014

56/031

31 TEST

BLDG 597 A 107

C.W. MAKEUP TO REHEAT SYSTEM

CHEMICALS

237479 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE

50/023

32 TEST

BLDG 597 A 107

C.W. MAKEUP LIEBERT UNITS

CHEMICALS

155022 / HIGH

YES

R.P.B.P.

WATTS

909

TESTED DEVICE

50/024

33 FP

BLDG 597 A 213

FIRE PROTECT SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

34 EXIST

BLDG 597

3 HOSE BIBBS 1 SERVICE SINK

CHEMICALS / SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

35 TEST

BLDG 509 NO SIDE A WING

LAWN SPRINKLER SYS

LAWN CHEMICALS

156834 / HIGH

YES

R.P.B.P.

WATTS

909

11/2"

DEVICE HAS BEEN REMOVED ACCORDING TO BLDG PLUMBER 5/12/99

36 TEST

BLDG 500 FRONT LAWN

LAWN SPRINKLER SYS

LAWN CHEMICALS

156834 / HIGH

YES

R.P.B.P.

WATTS

909

TESTED DEVICE

50/018

37 TEST

BLDG 500 S SIDE A WING

LAWN SPRINKLER SYS

LAWN CHEMICALS

HIGH

YES

R.P.B.P.

WATTS

909

11/2"

DEVICE HAS BEEN REMOVED ACCORDING TO BLDG PLUMBER 5/12/99

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

38 TEST

BLDG. 5O1 U144

OIL COOLER MAKEUP

CHEMICALS, OIL, FREON

HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

DEVICE REMOVED ACCORDING TO BLDG. PLBR NELSON 7/20/99

39 TEST

BLDG 501 U 144

C.W. MAKEUP TO REHEAT SYSTEM

CHEMICALS

89800 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

DEVICE DELETED, NO LONGER NEEDED 4/5/05 NELSON

50/011

40 TEST

BLDG 501 L 138

C.W. MAKEUP TO ABANDONED CHILLER

CHEMICALS / STAGNANT WATER

HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

DEVICE HAS BEEN REMOVED ACCORDING TO BLDG. PLUMBER NELSON / LEWIS 7/20/99

41 TEST

BLDG 501 L 112A

C.W. MAKEUP TO REHEAT SYSTEM

CHEMICALS

HIGH / A05932

YES

R.P.B.P.

WATTS

OO9

TESTED DEVICE

56/001

42 FP

BLDG 501 V 145

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW / 00139

YES

D.C.V.

WATTS

770

TESTED DEVICE

50/012

43 TEST

BLDG 501 U 145

C.W. MAKE-UP TO REHEAT SYSTEM

CHEMICALS

12702 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TEST DEVICE

50/013

45 TEST

BLDG 501 U 145

C.W. MAKE-UP TO AIR HANDLER

CHEMICALS WELL WATER

14496 / HIGH

YES

R.P.B.P.

WATTS

909

1 1/2"

TESTED DEVICE

50/014

46 TEST

BLDG 501 U 145

C.W. MAKE-UP GLYCOL TANK

GLYCOL

A09974 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

TESTED DEVICE

50/015

47 TEST

BLDG 501 U 145

C.W. MAKE-UP TO DIESEL JACKET WATER

CHEMICALS

O5723 / HIGH

YES

R.P.B.P.

WATTS

OO9

1 1/4"

TESTED DEVICE

50/016

48 TEST

BLDG 501

12 HOSE BIBBS 4 SERVICE SINKS

CHEMICALS SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

49 TEST

BLDG 500 1 G HALLWAY

C.W. MAKE-UP TO HOT WATER

CHEMICALS

Unknown/ HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE

50/017

50 FP

BLDG 522 MECH RM

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

S.C.V.

RELIABLE

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

51 TEST

BLDG 407 MECH RM 12

C.W. MAKE-UP TO REHEAT SYSTEM

CHEMICALS

128447 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE

50/018

52 TEST

BLDG 407

2 HOSE BIBBS, 5 WALL HYD, 1 SERVICE SINK

CHEMICALS SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

53 TEST

BLDG 513 MECH RM

C.W. MAKE-UP TO BOILER & VACUUM PUMP

CHEMICALS & SALIVA

HIGH / 137326

YES

R.P.B.P.

WATTS

OO9

3/4"

TESTED DEVICE

50/019

54 TEST

BLDG 513

2 HOSE BIBBS, 2 WALL HYD, 1 SERVICE SINK

CHEMICALS SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

55 TEST

BLDG 519 CELL 5

C.W. MAKE-UP TO COOLING TOWER

CHEMICALS / LEGIONAIRES DISEASE

HIGH

YES

R.P.B.P.

WATTS

OO9

DEVICE HAS BEEN REMOVED AND PIPED FROM CELL 1

56 TEST

BLDG 519 CELL 1

C.W. MAKE-UP TO COOLING TOWER

CHEMICALS / LEGIONAIRES DISEASE

27715 / HIGH

YES

R.P.B.P.

WATTS

OO9

TESTED DEVICE

50/020

57 TEST

BLDG 519 CELL 1

C.W. MAKE-UP TO COOLING TOWER

CHEMICALS / LEGIONAIRES DISEASE

02785 / HIGH

YES

R.P.B.P.

WATTS

OO9

TESTED DEVICE

50/021

58 TEST

BLDG 518

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

HIGH / 2CL0889

YES

R.P.B.P.

AMES

2000SS

TESTED DEVICE

58/01

60 TEST

BLDG 518

GENERATOR JACKET WATER BOILER MAKEUP

OIL GLYCOL CHEMICALS

HIGH / 122185

YES

R.P.B.P.

WATTS

909

1 1/2"

TESTED DEVICE

50/022

61 EXIST

BLDG 591

2 HOSE BIBBS 2 WALL HYDRANTS

CHEMICALS SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

62 TEST

BLDG 4000 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

127796 / HIGH

YES

R.P.B.P.

WATTS

909

1 1/4"

DEVICE IS REMOVED 8/26/06 ROBLES

50/036

63 FP

BLDG 4000 BOILER RM

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

9601261251 / LOW

YES

D.C.V.

FEBCO

850 DC

Hospital Maintenence

9/28/10

56/03

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

64 TEST

BLDG 4000 BOILER RM

C.W. MAKE-UP TO BOILER & CHILLER

CHEMICALS

477504 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Hospital Maintenence

9/17/10

50/037

65 TEST

BLDG 4000 BOILER RM

COLD WATER SUPPLY TO BOILER

CHEMICALS

SH782 / HIGH

YES

R.P.B.P.

CONBRACO

40205T2

Hospital Maintenence

9/10/10

51/011

66 TEST

BLDG 4000 RM GD08

COLD WATER SUPPLY TO CHEM CLEAN

CHEM / SOAP

A27664 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/036

67A TEST

BLDG 4000 Main Entrance

C.W. SUPPLY TO LAWN SPRINKLER

CHEMICAL / FERTILIZERS

HIGH / 197507

YES

R.P.B.P.

WATTS

OO9M2

Hospital Maintenence

8/12/10

50/038

68 TEST

BLDG 4000 BOILER RM

C.W. MAKE-UP TO COOLING TOWER

CHEMICALS/ LEGIONAIRES DISEASE

89975 / HIGH

YES

R.P.B.P.

WATTS

OO9

Hospital Maintenence

9/17/10

50/039

69 TEST

BLDG 4000 BOILER RM

DOMESTIC WATER MAIN

CONTAMINATES FROM HOSPITAL

25478 /HIGH

YES

R.P.B.P.

WATTS

OO9

Hospital Maintenence

9/10/10

50/040

70 TEST

BLDG 4000 BOILER RM

DOMESTIC WATER MAIN BY-PASS

CONTAMINATES FROM HOSPITAL

06534 /HIGH

YES

R.P.B.P.

WATTS

OO9

Hospital Maintenence

9/21/10

50/041

71 TEST

BLDG 4000 KITCHEN

LAUNDRY ROOM BY KITCHEN

HIGH / 247753

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

8/22/10

50/042

72 TEST

BLDG 4000 KITCHEN

LAUNDRY ROOM BY KITCHEN

C.W. MAKE UP TO SOAP DISPENSER

HIGH /

YES

R.P.B.P.

WATTS

OO9

1/2"

REMOVED FROM INVENTORY. DEVICE NO LONGER EXISTS

73 TEST

BLDG 4000 JANITOR G105

CLEANING CHEM MIX STATION

CHEMICALS / SOAP

HIGH / A26777

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/050

74 TEST

BLDG 4000 LAB GB07

C.W. SUPPLY TO CHEMISTRY ANALYZER

BLOOD TESTER

HIGH / A26791

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/059

75 TEST

BLDG 4000 RADIOLOGY IJ08-A

C.W. MAKE-UP TO X-RAY PROCESSOR

CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Decice Removed

50/043

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

76 TEST

BLDG 4000 RADIOLOGY 1008-A

C.W. MAKE-UP TO X-RAY PROCESSOR

CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed

50/044

77 VB

BLDG 4000 RADIOLOGY 1008-A

2 HOSE BIBBS 1 SERVICE SINK

CHEMICALS SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

78 TEST

BLDG 4000 MAMOGRAPHY 1002-B

C.W. MAKE-UP TO X-RAY PROCESSOR

CHEMICALS

55126 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

8/7/10

50/045

79 TEST

MAKEUP WATER TO X-RAY PROCESSOR

CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

OO9QT

1/2"

Device Removed 9/8/08 Robles/Pyle

N/A

50/046

80 TEST

MAKEUP WATER TO X-RAY PROCESSOR

CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed 9/8/08 Robles/Pyle

N/A

50/047

81 TEST

BLDG 4000 DENTAL LAB

C.W. MAKE-UP TO PERO. AIR COND

FREON OIL

HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

DEVICE IS STILL IN PLACE, BUT AIR CONDITIONING EQUIP HAS BEEN REMOVED. GREG KIEPKE 8/13/99

82 TEST

BLDG 4000 S MECH RM

C.W. MAKE-UP TO WATER SOFTENER

SODIUM CHEMICALS

88414 / HIGH

YES

R.P.B.P.

FEBCO

825Y

DEVICE NO LONGER EXISTS DELETE FROM INVENT 6/13/05

56/04

83 VB

BLDG 4000 S MECH RM

5 HOSE BIBBS 1 SERVICE SINK

CHEMICALS SEWAGE

LOW

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

84 FP

BLDG 4000 S MECH RM

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

9601301340 / LOW

YES

D.C.V.

FEBCO

850

Hospital Maintenence

9/28/10

56/05

85 TEST

BLDG 4000 S MECH RM

C.W. MAKE-UP TO CHILLER

CHEMICALS

547163 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Hospital Maintenence

9/10/10

50/048

86 TEST

BLDG 4000 S MECH RM

C.W. MAKE-UP PERIMETER HTG.

CHEMICALS

127069 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Hospital Maintenence

9/10/10

50/049

87 TEST

BLDG 4000 S MECH RM

C.W. MAKE-UP TO VACUMM RECEIVERS

CHEMICALS WASTE

147752/ high

YES

R.P.B.P.

WATTS

909

1 1/2"

Hospital Maintenence

9/10/10

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMPLETED

TOTAL

NXT YR.

TYPE #

MAKE

MODEL

SIZE

88 TEST

BLDG 4000

C.W. MAKE-UP TO COOLING TOWER

GLYCOL / RUST

56161 / HIGH

YES

R.P.B.P.

WATTS

009M2

1/2"

Hospital Maintenence

8/10/10

50/051

89 TEST

BLDG 4000 gi27

H.W. MAKE-UP TO EMBALMING

CHEMICAL

HIGH / 57213

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/22/10

50/052

90 TEST

BLDG 4209 MECH RM

C.W. MAKE-UP TO CHILLER

CHEMICALS

386525 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE

50/053

91 TEST

BLDG 4209 MECH RM

C.W. MAKE-UP TO AIR COMPRESSOR

COMPRESSOR OIL

124967/ HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

TESTED DEVICE

50/054

92 VB

BLDG 4209 MECH RM

1 SERVICE SINK 6 WALL HYD. 4 HOSE BIBBS

CHEMICALS SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

93 FP

BLDG 4209 BOILER RM

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

NDL96/LOW

YES

D.C.V.

CONBRACO

TESTED DEVICE

51/012

94 TEST

BLDG 4209 BOILER RM

LAWN IRRIGATION SYSTEM

LAWN CHEMICALS

06571/HIGH

YES

R.P.B.P.

WATTS

OO9

1 1/2"

TESTED DEVICE

50/055

95 TEST

BLDG 4209 BOILER RM

C.W. MAKE-UP TO BOILER & CHILLER

CHEMICALS

89830 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

TESTED DEVICE

50/056

96 FP

BLDG 3998

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

RELIABLE

No Longer Our Device, Belongs to Contractor

9/13/08

53/001

97 TEST

BLDG 4000 BOILER RM

C.W. MAKE-UP TO DOM. H.W. HEAT EXCH.

CHEMICALS

88972 / HIGH

YES

R.P.B.P.

WATTS

OO9

Hospital Maintenence

9/17/10

50/057

99 TEST

BLDG 4000 gi27

C.W. MAKE-UP TO EMBALMING

BIOLOGICAL WASTE

55121 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/22/10

50/057

100 TEST

BLDG 4000 KITCHEN

C.W. MAKE-UP TO DOM. H.W. HEAT EXCH.

CHEMICALS

05713 / HIGH

YES

R.P.B.P.

WATTS

OO9

1 1/4"

Hospital Maintenence

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

101 TEST

BLDG 457 RM 235

C.W. MAKE-UP TO LIEBERT UNIT

CHEMICALS

57203 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

TESTED DEVICE

50/060

102 FP

BLDG 457 MECH RM 515

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

CSC

176-F

2 1/2"

103 FP

BLDG 457 RM 273

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

352

104 FP

BLDG 457 RM 273

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

AUTO SPRINKLER

2 1/2"

105 FP

BLDG 457 RM 273

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

AUTO SPRINKLER

2 1/2"

106 FP

BLDG 457 RM 456

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

AUTO SPRINKLER

17.5F

2 1/2"

107 FP

BLDG 457 RM 456

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

AUTO SPRINKLER

17.5F

2 1/2"

108 FP

BLDG 457 RM 651

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

VALVE PAINTED--NO MAKE OR MODEL

109 FP

BLDG 457 RM 6515

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

AUTO SPRINKLER

352

110 FP

BLDG 457 RM615

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

VALVE PAINTED--NO MAKE OR MODEL

111 FP

BLDG 457 RM 593

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

AUTO SPRINKLER

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

112 FP

BLDG 457 RM 551

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

CSC

2 1/2"

113 FP

BLDG 457 RM 551

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

AUTO SPRINKLER

2 1/2"

114 FP

BLDG 457 BOILER RM

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

AUTO SPRINKLER

116 TEST

BLDG 457 RM 665

C.W. MAKE-UP TO HYD. TEST STAND

HYDRAULIC OIL CHEMICALS

233505 / HIGH

YES

R.P.B.P.

WATTS

OO9

TESTED DEVICE

50/025

117 TEST

BLDG 457 RM 665

C.W. MAKE-UP TP WASH TANKS

CHEMICALS SOAP

55146 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

TESTED DEVICE

50/026

118 TEST

BLDG 457 RM 651

C.W. MAKE-UP TO WELDERS

CHEMICALS

89815 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

TESTED DEVICE

50/027

119 TEST

C.W. SUPPLY TO BOILER

STAGNENT WATER / CHEMICALS

228878 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device removed

3/6/07

50/028

120 VB

BLDG 457 RM 636

2 HOSE BIBBS

CHEMICALS

HIGH

YES

SCREW-ON VACUUM BREAKERS

WATTS

5/8"

121 TEST

BLDG 457 RM 593

C.W. MAKEUP TO MANIFOLD TESTER

CHEMICALS

55160 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

TESTED DEVICE

50/029

122 VB

BLDG 457 RM 593

12 HOSE BIBBS 4 SERVICE SINKS

CHEMICALS

HIGH

YES

SCREW ON VACUUM BREAKER

WATTS

5/8"

123 TEST

BLDG 304 CHILL

C.W. SUPPLY TO COOLING TOWER

STAG WATER / CHEMICALS

120570 / HIGH

YES

R.P.B.P.

WATTS

909

21/2"

TESTED DEVICE

50/030

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

124 TEST

BLDG 493 EQUIP ROOM

C.W. SUPPLY TO BLDG ISOLATION

UNKNOWN

20522 / HIGH

YES

R.P.B.P.

WATTS

909

TESTED DEVICE

2/25/14

50/245

125 TEST

BLDG 457 RM 564

C.W. MAKEUP TO PARTS WASHER

CHEMICALS

89762 / HIGH

YES

R.P.B.P.

WATTS

009M2

3/4"

TESTED DEVICE

50/031

126 TEST

BLDG 457 RM 944

C.W. MAKEUP TO CHILLER & COOL TOWER

CHEMICALS

89973 / HIGH

YES

R.P.B.P.

WATTS

009M1

TESTED DEVICE

50/032

127 TEST

BLDG 457 RM 936

SOAP RM. EQUIP, HEAT EX F/HEAT SYS.

SOAP CHEMICALS

HIGH / 14494

YES

R.P.B.P.

WATTS

009m2

11/2"

TESTED DEVICE

3/11/14

56/002

128 TEST

BLDG 457 RM 936

C.W. MAKEUP TO BOILER

CHEMICALS

07224 / HIGH

YES

R.P.B.P.

WATTS

OO9

TESTED DEVICE

50/033

129 TEST

BLDG 457 BOILER RM

C.W. MAKEUP TO BOILERS & CHILLERS

CHEMICALS

20315 / HIGH

YES

R.P.B.P.

WATTS

OO9

21/2"

TESTED DEVICE

50/034

130 TEST

BLDG 457 BOILER RM

C.W. MAKEUP TO DOM.H.W. HEAT EXCH.

CHEMICALS

89974 / HIGH

YES

R.P.B.P.

WATTS

OO9

TESTED DEVICE

50/035

131 TEST

BLDG 493 RM 103

COLD WATER SUPPLY TO BOILER

STAGNENT WATER / CHEMICALS

228878 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

TESTED DEVICE

50/028

132 TEST

BLDG 47 SE CORNER

C.W. MAKEUP TO IRRIG. SYS

CHEMICALS

A05214 / HIGH

YES

R.P.B.P.

FEBCO

860

1/2"

Not Currently Installed 4/27/07

4/27/10

50/061

134 TEST

BLDG 47 NE CORNER

C.W. MAKEUP TO IRRIG. SYS.

CHEMICALS

215082 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Not Currently Installed 4/27/07

4/27/10

50/062

136 TEST

BLDG 29 ON FENCE

C.W. MAKEUP TO IRRIG. SYS.

CHEMICALS

63402 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Not Currently Installed 4/27/07

4/27/10

50/063

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

138 TEST

BLDG 495 NORTH

C.W. MAKEUP TO HOSE BIBB

CHEMICALS

566628 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE 6/11/13 Robles/Bodell

6/11/14

50/064

140 TEST

BLDG 592 LIFT STATION

C.W. MAKEUP TO HOSE BIBB

CHEMICALS

290248/ HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE

50/065

142 TEST

BLDG 552

C.W. MAKEUP TO FIRE SUPPRESS

CHEMICALS/AFFF

0011291346/ HIGH

YES

R.P.B.P.

FEBCO

860

TESTED DEVICE 6/13/13 Alves

6/13/14

50/066

143 TEST

146 TEST

288 MECH RM

C.W. MAKEUP TO Lawn Irrigation

CHEMICALS

H08561/High

YES

R.P.B.P.

FEBCO

860

TESTED DEVICE 3/19/2013 Robles/Dean

3/19/14

50/68

148 TEST

288 MECH RM

C.W. SUPPLY TO FIRE SUPPRESSION

STAGNET WATER

NW262 / LOW

YES

R.P.B.P.

CONBRACO

6DC

TEST DEVICE 3/18/13 ALVES

3/18/14

50/069

150 TEST

288 TRUCK BAY

C.W. SUPPLY TO FIRE TRUCK FILL

STAGNET WATER

F0302261124 / HIGH

YES

R.P.B.P.

FEBCO

860

TEST DEVICE 3/19/13 ROBLES/Dean

3/19/14

50/70

152 TEST

288 TRUCK BAY

C.W. SUPPLY TO FIRE TRUCK FILL

STAGNET WATER

F0407151401 / HIGH

YES

R.P.B.P.

FEBCO

860

TESTED DEVICE 3/11/13 ROBLES/Dean

3/11/14

50/071

154 TEST

288 MECH RM

C.W. SUPPLY TO BUILDING ISOLATION

CHEMICALS

HIGH / F0407151529

YES

R.P.B.P.

FEBCO

860

3/4"

TESTED DEVICE 3/12/13 ROBLES/Dean

3/12/14

50/072

156 TEST

BLDG 565 CSTS

C.W. MAKE-UP TO MISC.

CHEMICALS

HIGH / 18973

YES

R.P.B.P.

WATTS

OO9M3

3/4"

TESTED DEVICE 4/17/2013 Robles/Dean

3/17/14

50/073

158 TEST

BLDG 9950 KITCH

COLD WATER SUPPLY TO SOAP DISP

CHEMICALS

A09492 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

TESTED DEVICE 4/9/13 Robles/Dean

4/9/14

50/074

160 TEST

BLDG 9950 KITCH

COLD WATER SUPPLY TO DISPOSER

SEWAGE

HIGH / A09920

YES

R.P.B.P.

WATTS

OO9

1/2"

TESTED DEVICE 4/9/13 Robles/DEAN

4/9/14

50/075

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR

TYPE #

MAKE

MODEL

SIZE

162 TEST

BLDG 809 FAM

C.W. SUPPLY TO FAM CAMP AREA

ISOLATION DEVICE

HIGH / 433881

YES

R.P.B.P.

WATTS

909

TESTED DEVICE 4/16/13 Robles/Dean

4/16/14

50/361

164 TEST

727 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

137493 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device is out of service, building is pickled.

50/077

166 TEST

728 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

469431 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device is out of service, building is pickled.

50/078

168 TEST

729 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

130257 /HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device is out of service, building is pickled.

50/079

170 TEST

730 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

131566 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

172 TEST

731 BOILER RM

C.W. MAKEUP TO BOILER

CHEMICALS

469431 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

174 TEST

732 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

128946 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

176 TEST

733 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

128943 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

178 TEST

734 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

130221 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

180 TEST

735 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

128952 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

182 TEST

736 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118445 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

184 TEST

737 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

130205 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

186 TEST

738 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118442 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

188 TEST

739 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

128940 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

190 TEST

740 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118447 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

192 TEST

741 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118450 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

194 TEST

742 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

139255 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

196 TEST

743 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118503 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

198 TEST

744 BOILER RM

C.W. MAKE-UP TO BOILERS

CHEMICALS

118439 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

200 TEST

745 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

128953 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

202 TEST

746 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118509 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

204 TEST

747 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118440 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

206 TEST

748 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

130250 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

208 TEST

749 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118404 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BUILDING HAS BEEN DEADLINED

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

210 FP

BLDG 586

C.W. SUPPLY TO FIRE SUPPRESSION

RUST STAGNANT WATER

0001261015/LOW

YES

DCV

FEBCO

770

TESTED DEVICE

56/029

216 TEST

BLDG 585 LAB

C.W. MAKE-UP TO LAB SINK

CHEMICALS

06122 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/8"

TESTED DEVICE

50/081

218 TEST

BLDG 524 RM. 227

C.W. MAKE-UP TO SOAP DISP

CHEMICALS

A21625 / HIGH

YES

R.P.B.P.

WATTS

909

1/2"

TESTED DEVICE

50/082

220 TEST

BLDG 4000 ROOM GJ19-A

C.W. MAKE-UP TO STERLIZER

A12272 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/22/10

50/129

222 TEST

BLDG 4000 RM GJ16-A

C.W. MAKE-UP TO STEAM MACHINE

A03001 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

Hospital Maintenence

9/22/10

50/130

224 TEST

BLDG 4000 RM 1L13

WATER SUPPLY TO STERILIZER

CHEMICALS

06138 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/8"

Hospital Maintenence

9/11/10

50/138

226 TEST

BLDG 4000 RMGJ16B

WATER SUPPLY TO STERILIZER

CHEMICALS

06136 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/8"

Hospital Maintenence

9/22/10

50/132

228 TEST

BLDG 4000 RMGJ19-B

WATER SUPPLY TO STERILIZER

CHEMICALS

06125 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/8"

Hospital Maintenence

9/22/10

50/080

230 TEST

BLDG 4000 2P07

WATER SUPPLY TO STERILIZER

CHEMICALS

A202111 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

Hospital Maintenence

9/16/10

50/087

232 TEST

BLDG 4000 HOSP TOWER

SUPPLY FILTER COOLING TOWER

CHEMICALS

A26846 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/10/10

50/088

234 TEST

Bldg 4000 rm 2p07

C.W. MAKEUP TO Steris sterlizer

CHEMICALS

A25503 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

Hospital Maintenence

9/16/10

50/089

236 TEST

Bldg 4000 Rm 2001 Dental

C.W. MAKEUP TO Curing Machine

UNKNOWN

A26774 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/22/10

50/090

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

238 TEST

Bldg 4000 Rm G123-B

C.W. MAKEUP TO STERILIZER

UNKNOWN

A20212 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

Hospital Maintenence

9/22/10

50/091

240 TEST

Bldg 4000 RM GJ15

C.W. MAKEUP TO chem mix station

CHEMICALS

A21647 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/22/10

50/092

242 TEST

Bldg 4000 Rm GB07-B

C.W. MAKEUP TO chem mix station

CHEMICALS

A12304 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/094

244 TEST

Bldg 4000 Rm 217

C.W. MAKEUP TO chem mix station

CHEMICALS

A21612 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/22/10

50/096

246 TEST

Bldg 4000 Rm 1E41

C.W. MAKEUP TO chem mix station

CHEMICALS

A21623 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/22/10

50/095

248 TEST

Bldg 4000 Rm GJ05

C.W. MAKEUP TO chem mix station

CHEMICALS

A26799 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/093

250 TEST

Bldg 4000 Rm 261

C.W. MAKEUP TO chem mix station

CHEMICALS

A12345/ HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/16/10

50/097

252 TEST

Bldg 4000 Rm2P05

C.W. MAKEUP TO chem mix station

CHEMICALS

HIGH / A26820

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/098

254 TEST

BLDG 4000 RM1K23

C.W. SUPPLY TO CHEM DISP UNIT

CHEMICALS

A26923 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/099

256 TEST

BLDG 4000 RM 232

C.W. SUPPLY TO CHEM DISP UNIT

CHEMICALS

A26819 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/100

258 TEST

BLDG 4000 RM 323

C.W. SUPPLY TO CHEM DISP UNIT

CHEMICALS

A21571 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/101

260 TEST

BLDG 4000 RMIL28

C.W. SUPPLY TO CHEM DISP UNIT

CHEMICALS

A27987/ HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/102

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

262 TEST

BLDG 4000 RM1L36

C.W. SUPPLY TO CHEM DISP UNIT

CHEMICALS

A21559 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Hospital Maintenence

9/11/10

50/103

264 TEST

BLDG 4000 S MECH RM

C.W. SUPPLY BLDG ISOLATION

CHEMICALS / BIO

252640 / HIGH

YES

R.P.B.P.

WATTS

909

Hospital Maintenence

9/23/10

50/104

266 TEST

301 BOILER RM

C.W. MAKE-UP TO HOT WATER BUNDLE

CHEMICALS

468513 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE 2/12/13 ROBLES/Dean

2/13/14

50/105

268 TEST

BLDG 4000 RM 2P01

WATER MAKE-UP TO STERLIZER

CHEMICALS

A10264 / HIGH

YES

R.P.B.P.

WATTS

909

Hospital Maintenence

3/4/10

50/106

270 TEST

BLDG

C.W. SUPPLY TO BLDG

CHEMICALS

NBD83/LOW

YES

R.P.B.P.

WATTS

Unkn

Device is out of service, building is pickled.

5/11/10

50/107

272 TEST

784 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

468511 / HIGH

YES

R.P.B.P.

WATTS

20002

3/4"

Device is out of service, building is pickled.

4/12/02

50/108

274 TEST

785 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

118423 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device is out of service, building is pickled.

1/7/01

50/109

276 TEST

786 BOILER RM

C.W. MAKE-UP TO BOILER

CHEMICALS

130242 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device is out of service, building is pickled.

50/110

278 TEST

787 BOILER RM

C.W. MAKE-UP TO BOILERS

CHEMICALS

130229 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device is out of service, building is pickled.

50/111

285 A NEW

TRAINING EXC AREA

1 FIRE HYDRANT

WATER

LOW

YES

R.P.B.P.

WATTS

009M2

SOMETIMES CAN BE USED TO FILL WATER TRUCK. IF THAT HAPPENS A TEMP DEVICE IS INSTALLED

286 TEST

Bldg 363 ARTS & CRAFTS

C.W. MAKE-UP TO BOILER

CHEMICALS

89790 / HIGH

YES

R.P.B.P.

WATTS

009M2

3/4"

TESTED DEVICE 2/11/13 ROBLES/Dean

50/112

287 TEST

BLDG 282

C.W SUPPLY TO BLDG ISOLATION

WATER

LK135 / LOW

YES

RPBP

WILKINS

40205TC2

TESTED DEVICE

60/005

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

288 TEST

BLDG 282

C.W. SUPPLY TO FIRE SUPPRN.

STAGNENT WATER / RUST

FH-2938 / LOW

YES

D.C.V.

WATTS

757 DC

TESTED DEVICE

50/375

289 TEST

BLDG 660

C.W. SUPPLY TO UNKN

WATER

48285/HIGH

YES

RPBP

WATTS

009QT

TESTED DEVICE

50/115

290 TEST

BLDG 405

C.W. MAKEUP TO AIR CONDITIONER

FREON OIL STAGNANT WATER

124912/HIGH

YES

R.P.B.P.

WATTS

009M2

3/4"

Removed From Service 2/26/06 Robles/Pyle

50/114

292 TEST

BLDG 463 MECH RM

C.W. MAKEUP TO A/C & HEAT SYSTEM

CHEMICALS

131549 / HIGH

YES

R.P.B.P.

WATTS

009M2

3/4"

TESTED DEVICE 2/19/13 ROBLES/Dean

2/19/14

50/116

293 FP

BLDG 402 MECH RM

C.W. SUPPLY TO FIRE SUPPRESSION

RUST STAGNANT WATER

LOW /

YES

D.C.V.

FEBCO

850

Bldg Pickeled 11/23/09 Will be torn down in the spring

296 TEST

BLDG 400 MECH RM

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

114921 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BLDG DESTROYED DEVICE REMOVED

6/24/09

50/117

298FP

BLDG 400 MECH.

C.W. SUPPLY TO FIRE SUPR SYSTEM

RUST STAGNANT WATER

9901261640 / LOW

YES

D.C.V.

FEBCO

850

21/2"

BLDG DESTROYED DEVICE REMOVED

6/24/09

56/06

300 TEST

BLDG 402 MECH RM

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Bldg Pickeled 11/23/09 Will be torn down in the spring

50/357

302 TEST

BLDG 402 MECH RM

C.W. MAKEUP TO DOM. H.W. HEAT EXCH.

CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

OO9

11/2"

Bldg Pickeled 11/23/09 Will be torn down in the spring

50/358

307 TEST

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

HIGH

YES

R.P.B.P.

WATTS

909

3/4"

50/118

308 TEST

BLDG 135 MECH

C/W SUPPLY TO BLDG ISOLATION

CHEMICALS

A02687 / HIGH

YES

R.P.B.P.

WATTS

009QT

11/2"

TESTED DEVICE

50/119

309 TEST

BLDG 525 MECH RM

C.W. MAKE-UP TO HEAT SYS

CHEMICALS

600592 / HIGH

YES

R.P.B.P.

WATTS

909

3/4

TESTED DEVICE 2/19/13 ROBLES/Dean

2/19/14

50/120

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

310 TEST

BLDG 525 MECH RM

C.W. MAKEUP TO DOM. H.W. HEAT EXCH.

CHEMICALS

89977 / HIGH

YES

R.P.B.P.

WATTS

009M1

TESTED DEVICE 2/19/13 ROBLES/Dean

2/19/14

50/121

313 TEST

BLDG 526 MECH RM

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

114712 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE2/20/13 ROBLES/Deanm

2/20/14

50/122

314 TEST

BLDG 526 MECH RM

C.W. MAKEUP TO DOM. H.W.HEAT EXCH.

CHEMICALS

89976 / HIGH

YES

R.P.B.P.

WATTS

OO9

TESTED DEVICE 2/20/13 ROBLES/DEAN

2/20/14

50/123

317 TEST

BLDG 527 MECH RM

MASTER RPBP ON WATER SERVICE

UNKNOWN

N5888 / HIGH

YES

R.P.B.P.

CON-BRACO

4020902

21/2"

TESTED DEVICE 3/4/13 ROBLES/DEAN

3/4/14

51/03

318 TEST

BLDG 527 MECH RM

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

568896 / HIGH

YES

R.P.B.P.

WATTS

909

TESTED DEVICE 3/4/13 ROBLES/Dean

3/4/14

51/04

321 TEST

BLDG 457 NDI RM

C.W. MAKEUP Film Develpor

CHEMICALS

HIGH/ 80560

YES

R.P.B.P.

WATTS

009QT

1/2"

TESTED DEVICE 6/3/13 Robles/Dean

6/3/14

50/124

322 TEST

BLDG 451 MECH RM

C.W. MAKEUP TO COOLING TOWER

CHEMICALS / LEGIONAIRES DISEASE

HIGH 05657

YES

R.P.B.P.

WATTS

OO9

2 1/2"

TESTED DEVICE 6/3/13 Robles/Dean

6/3/14

50/125

325 FS

BLDG 404 YOUTH CENTER

C.W. SUPPLY TO FIRE SUPR SYSTEM

RUST STAGNANT WATER

AH3484 LOW

YES

D.C.V.

FEBCO

805Y

TESTED DEVICE 2/14/13 Alves

2/14/14

56/025

326 TEST

BLDG 9958 PATRIOT

C.W. SUPPLY TO HEAT SYSTEM

CHEMICALS / LEGIONAIRES DISEASE

HIGH / A02526

YES

R.P.B.P.

FEBCO

860

2/23/2009 Removed from inventory, Tesred by Housing Maintenance

2/23/10

327 TEST

BLDG 9958 PATRIOT

C.W. SUPPLY TO FIRE SUPR SYSTEM

RUST STAGNANT WATER

LOW / 9954301217

YES

D.C.V.

FEBCO

850

2/23/2009 Removed from inventory, Tesred by Housing Maintenance

2/27/10

328 TEST

BLDG 404 BOILER RM

C.W. MAKEUP TO BOILER FILL

CHEMICALS

568627 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE 1/28/13 Robles/Dean

1/28/14

50/126

329 TEST

BLDG 565 Hanger Area

HOT WATER SUPPLY TO HOSE REEL

FUEL / SOAP CHEMICALS

008855 / HIGH

YES

P.V.B.

WATTS

800M4

11/2"

TESTED DEVICE 4/22/13 Robles/Deanm

4/22/14

50/323

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

331 TEST

BLDG 9958 BOILER RM

C.W. SUPPLY TO LOOP SYSTEM

RUST STAGNANT WATER

67860 / HIGH

YES

R.P.B.P.

WATTS

009M2

PATRIOT MAINTENCE TO TEST AND REPORT RESULTS TO MUD

5/25/09

50/11

333 TEST

BLDG 323 RM 119

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

180242 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE 2/11/13 ROBLES/Dean

2/11/14

50/127

334 TEST

BLDG 362

C.W. MAKEUP TO HOTSY CAR WASH

SOAP CHEMICALS

63996 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

TESTED DEVICE

50/128

335 FP

BLDG 362 MECH RM

FIRE PROTECTION SYSTEM

RUST STAGNANT WATER

LOW

YES

SINGLE CHECK VALVE

2 1/2"

337 TEST

BLDG 789 MECH RM

ISOLATION VALVE BETW EEN BASE & CITY

NONE

LOW

YES

D.C.V.

WATTS

709

DEVICE TESTED BY OUTSIDE CONTRACTOR YEARLY FOR FAA

338 TEST

BLDG 789 MECH RM

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

112350 / HIGH

YES

R.P.B.P.

WATTS

009M2

3/4"

DEVICE TESTED BY AN OUTSIDE CONTRACTOR YEARLY FOR FAA

341 TEST

BLDG 789 OUTSIDE

LAWN SPRINKLERS SYSTEM

LAWN CHEMICALS

O7273 / HIGH

YES

R.P.B.P.

WATTS

009M2

11/4"

DEVICE TESTED BY AN OUTSIDE CONTRACTOR YEARLY FOR FAA

342 TEST

BLDG 789 MECH RM

C.W. MAKEUP TO FLASH TANK

CHEMICALS STAGNANT WATER

O5151 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

DEVICE IS NO LONGER IN USE, AND IS REMOVED

343 TEST

BLDG 789 MECH RM

SOFT WATER MAKEUP TO BOILER

CHEMICALS STAGNANT WATER

113588 / HIGH

YES

R.P.B.P.

WATTS

009M2

3/4"

DEVICE TESTED BY AN OUTSIDE CONTRACTOR YEARLY FOR FAA

344 TEST

BLDG 280 MINI

C.W. SUPPLY TO SODA DISPENSER

306204 / HIGH

YES

R.P.B.P.

WATTS

009M2

1/2"

TESTED DEVICE

50/374

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

345 TEST

BLDG 280 MINI

POTABLE SUPPLY TO BLDG ISOLAT.

258969 / HIGH

YES

R.P.B.P.

WATTS

009M2QT

TESTED DEVICE

50/371

346 EXIST

BLDG 280 MINI

POTABLE SUPPLY TO LAWN IRRIG.

CHEMICAL

HIGH / 261258

YES

R.P.B.P.

WATTS

009M2QT

TESTED DEVICE

50/372

347 EXIST

BLDG 280 MINI

POTABLE SUPPLY TO FIRE SUPPR.

RUST / STAGNENT WATER

HIGH/FJ3033

YES

D.C.V.

AMES

COLT 200

TESTED DEVICE

58/07

348 TEST

BLDG 305 BOILER ROOM

C.W. MAKEUP TO WATR SOFTNR. & BOILER

SODIUM CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BLDG DESTROYED DEVICE REMOVED

50/257

354 TEST

BLDG 42 MECH RM

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

215795 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE

50/259

356 TEST

BLDG 165 MECH RM

C.W. MAKEUP TO CHILLER

CHEMICALS

63967 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

BLDG DESTROYED DEVICE REMOVED

2/20/09

50/263

357 TEST

BLDG 165 MECH RM

C.W. MAKEUP TO LAWN SPRINKLERS

LAWN CHEMICALS

132919 / HIGH

YES

R.P.B.P.

WATTS

909

1 1/2"

BLDG DESTROYED DEVICE REMOVED

2/20/09

50/134

358 TEST

BLDG 165 MECH RM

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

400745 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

BLDG DESTROYED DEVICE REMOVED

2/20/09

50/135

360 TEST

BLDG 165 KITCHEN

C.W. MAKEUP TO POP DISPENSER EQUIP

CARBONATION SYRUP

14144 / LOW

YES

R.P.B.P.

WATTS

OO9M3

3/4"

BLDG DESTROYED DEVICE REMOVED

2/20/09

50/136

365 TEST

BLDG 78 KITCHEN

C.W. TO WATER COOLED ICE MAKER

HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

50/137

366 TEST

YES

R.P.B.P.

WATTS

367 TEST

CHEMICALS

YES

R.P.B.P.

WATTS

009 RT

50/139

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOT

NXT YR.

TYPE #

MAKE

MODEL

SIZE

369 TEST

BLDG 327 MECH AREA

FIRE SUPRESSION SYSTEM

STAGNANT WATER / RUST

05108 / LOW

YES

D.C.V.

WATTS

770

TESTED DEVICE

50/140

370 TEST

C.W. MAKEUP TO DOM. H.W. HEAT EXCH.

STEAM CHEMICALS

YES

R.P.B.P.

WATTS

009M1

Backflow Removed 12/23/08 Robles/pyle

3/14/09

50/141

371 TEST

BLDG 41 BOILER RM

C.W. MAKEUP TO BOILERS

CHEMICALS

258966 / HIGH

YES

R.P.B.P.

FEBCO

825Y

TESTED DEVICE

56/07

375 TEST

BLDG 41 MECH RM

C.W. MAKEUP TO CHILLER

CHEMICALS

118412 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

DEVICE NO LONGER NEEDED. REMOVED 11/7/07 KIEPKE

50/142

376 TEST

BLDG 41 GARAGE

C.W. MAKE-UP TO BOILER

CHEMICALS SEWAGE

159835 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

TESTED DEVICE 2/19/13 ROBLES/DEAN

2/19/14

50/143

380 TEST

BLDG 113 MECH RM

C.W. MAKEUP TO CHILLER

CHEMICALS

469445 / HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device Removed 7 Feb 13 Bldg. DEMO

2/28/12

56/08

381 TEST

BLDG 113 MECH RM

C.W. MAKEUP TO WATER SOFTENER

SODIUM CHEMICALS

O5732 / LOW

YES

R.P.B.P.

WATTS

009M2

1 1/4"

Device Removed 7 Feb 13 Bldg. DEMO

2/28/12

50/144

384 TEST

BLDG 113 BASEMENT

C.W. MAKEUP TO AIR COMP. COOLER

FREON OIL CHEMICALS

57286 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed 7 Feb 13 Bldg. DEMO

3/14/12

50/145

385 TEST

YES

R.P.B.P.

WATTS

DEVICE REMOVED 3/2/04

386 TEST

LAWN CHEMICALS

YES

R.P.B.P.

WATTS

909

1 1/4"

backflow Removed 08/18/11 Robles/Bodell

6/6/12

387 TEST

BLDG 113 DELI

C.W. MAKEUP TO SOAP DISPENSER

SOAP CHEMICALS

57226 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed

6/3/09

50/147

388 TEST

BLDG 113 CAVALIER LOUNGE

C.W. MAKEUP TO CARBONATORS

SYRUP CARBONATION

LOW

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOTAL

NXT YR.

TYPE #

MAKE

MODEL

SIZE

389 TEST

BLDG 113 BALL RM LOUNGE

C.W. MAKEUP TO CARBONATORS

SYRUP CARBONATION

102015 / LOW

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed 7 Jan 13 Bldg. DEMO

3/8/12

50/149

390 TEST

BLDG 113 BALL RM LOUNGE

C.W. MAKEUP TO CARBONATORS

SYRUP CARBONATION

57204 / LOW

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed 7 Feb 13 Bldg. DEMO

3/8/12

50/150

391 TEST

BLDG 13 2ND FLR

WATER COOLED COMPRESSOR

FREON

06130 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/8"

TESTED DEVICE

50/151

396 TEST

BLDG 121 POOL AREA

C.W.MAKE-UP TO CHILD WADING POOL

CHEMICALS POOL WATER

14702 / HIGH

YES

R.P.B.P.

WATTS

OO9M2

1 1/2"

Device Removed

50/229

398 TEST

BLDG 73 MECH RM

C.W. MAKEUP TO BOILERS & AIR HANDLER

CHEMICALS

112341 / HIGH

YES

R.P.B.P.

WATTS

OO9

3/4"

TESTED DEVICE 3/18/13 ROBLES/DEAN

3/18/14

50/152

402 TEST

LAWN CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

3/4"

50/153

403 TEST

C.W. MAKEUP TO DENTAL EQUIP

ANIMAL WASTE

YES

R.P.B.P.

WATTS

OO9

1/2"

Backflow Removed 12/23/08 Robles/pyle

3/10/09

50/154

404 TEST

BLDG 78 MECH RM

C.W. MAKE-UP TO WATER SOFTENER

A00298 / HIGH

YES

R.P.B.P.

WATTS

OO9

1 1/4"

TESTED DEVICE

50/155

405 TEST

BLDG 517 WASH RACK

C.W. MAKE-UP TO PART WASHER

FUEL / SOAP CHEMICALS

A28994 / HIGH

YES

R.P.B.P.

WATTS

009M2

3/4"

TESTED DEVICE

50/156

406 TEST

BLDG 552 MECH

COLD WATER SUPPLY TO BLDG

FUEL / SOAP CHEMICALS

123986 / HIGH

YES

R.P.B.P.

WATTS

009M2

11/4"

TESTED DEVICE

50/157

407 TEST

BLDG 324 1 B WING

C.W. SUPPLY TO SOAP DISPENSER

SOAP CHEMICALS

A28585 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed 26 Apr 13

50/335

408 TEST

BLDG 324 2 B WING

C.W. SUPPLY TO SOAP DISPENSER

SOAP CHEMICALS

A21608 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed 26 Apr 13

50/336

409 TEST

BLDG 324 3 B WING

C.W. SUPPLY TO SOAP DISPENSER

SOAP CHEMICALS

A09233 / HIGH

YES

R.P.B.P.

WATTS

OO9

1/2"

Device Removed 26 Apr 13

50/337

INVENTORY OF CROSS-CONNECTION CONTROL AND BACKFLOW PREVENTION DEVICES

OFFUTT AFB

PERSONNEL MAKING INVENTORY:

CONTROL NO ISSUED

LOCATION

ITEM / FACILITY SYSTEM PROTECTED

POTENTIAL CONTAINMENT/POLLUTANT

DEGREE OF HAZARD / DEVICE SERIAL NUMBER

BACK PRESS POTENT

BACK SIPHONAGE POTENTIAL

TYPE CONTROL INSTALLED OR (REQUIRED)

DATA ON DEVICE INSTAL

COMMENTS

COMP

TOTAL

NXT YR.

TYPE #

MAKE

MODEL

SIZE

411 TEST

BLDG 40 MECH RM 56

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

11923 / HIGH

YES

R.P.B.P.

WATTS

009M1

1 1/4"

Device Removed

3/17/04

50/158

413 TEST

BLDG. 49 MECH. RM.

C.W. TO DOM. H.W. HEAT EXCHANGER

STEAM CHEMICALS

O7271 / HIGH

YES

R.P.B.P.

WATTS

009M2

1 1/4"

Device Removed

3/17/04

50/159

415 VB

BLDG 49 C.A.P.

2 HOSE BIBBS ON SINK

CHEMICALS SEWAGE

HIGH

YES

SCREW ON VACUUM BREAKERS

WATTS

5/8"

Device Removed

416 TEST

BLDG 49E RM. B110

C.W. MAKEUP TO HEAT SYSTEM

CHEMICALS

/ HIGH

YES

R.P.B.P.

WATTS

909

3/4"

Device Removed

50/160

This is the start of the file's text. The full file is on GovTribe.

File details come from the government source that posted it. Updated Jul 15, 2021.