Attachment A - Backflow Preventers Locations.docx

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J046--Backflow Prevention Testing
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36C25220Q0908
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Attachment A Backflow Preventers

Location: Hines VA Hospital Address: 5000 S. 5th Ave. Hines, IL 60141 Customer: Edward Hines VA Hospital

Device
Hazard
Serial
Install
Due
Inspection
1-1/4" Watts - 919 (RP)
wash station
8719
9/1/2016
8/20/2020
8/22/2019
8" Watts - 957 (RP)
domestic water
MK5185
11/11/2013
8/20/2020
8/22/2019
3/4" Wilkins - 950 (DC)
fp bypass
2756759
10/30/2017
8/20/2020
8/22/2019
1/2" Watts - 009 (RP)
boiler make up
390959
10/1/2016
8/20/2020
8/22/2019
1/2" Watts - 009 (RP)
sterilizer
332480
2/8/2017
8/20/2020
8/22/2019
4" Watts - 909 (RP)
cooling make up
217752
10/26/2017
8/20/2020
8/23/2019
1-1/2" Watts - 909 (RP)
temp hydrant
436400
5/20/2020
8/20/2020
5/20/2020
1" Apollo - RP4A (RP)
domestic water
610239
8/20/2015
8/20/2020
8/22/2019
1" Watts - 909 (RP)
domestic water
640787
8/20/2015
8/20/2020
6/8/2020
3/4" Apollo - RP4A (RP)
make up water
3611209
8/20/2015
8/20/2020
8/22/2019
1-1/4" Hersey - FRP II (RP)
make up water
1822
8/20/2015
8/20/2020
8/22/2019
2" Watts - 009 (RP)
non-potable wat
71111
8/26/2019
8/20/2020
8/26/2019
1" Watts - 009 (RP)
dishwasher
394053
9/1/2016
8/20/2020
8/23/2019
1-1/2" Watts - 009 (RP)
chiller make up
A30356
10/27/2017
8/20/2020
8/22/2019
3/4" Watts - 009 (RP)
make up water
91628
3/22/2016
8/20/2020
8/24/2019
6" Wilkins - 375 (RP)
domestic water
X08097
3/5/2016
8/20/2020
9/21/2019
1-1/2" Wilkins - 975 (RP)
irrigation
3123043
8/23/2019
8/20/2020
8/23/2019
1/2" Watts - 009 (RP)
washing machine
359931
8/20/2015
8/20/2020
8/22/2019
1-1/2" Watts - 909 (RP)
cage washer
434595
8/20/2015
8/20/2020
8/22/2019
3/4" Watts - 007 (DC)
make up water
246224
8/20/2015
8/20/2020
8/22/2019
3/4" Watts - 009 (RP)
make up water
A91575
8/20/2015
8/20/2020
8/22/2019
1" Watts - 009 (RP)
make up water
A18050
8/20/2015
8/20/2020
8/22/2019
1-1/4" Watts - 009 (RP)
make up water
A12864
8/20/2015
8/20/2020
8/22/2019
1" Watts - 009 (RP)
make up water
A57481
8/20/2015
8/20/2020
8/22/2019
3/4" Watts - 909 (RP)
air conditioner
610430
8/20/2015
8/20/2020
8/22/2019
3" Watts - 009 (RP)
domestic water
23454
8/20/2015
8/20/2020
8/26/2019
4" Ames - 2000SS (DC)
fire protection
2FM1127
8/20/2015
8/20/2020
8/26/2019
3/4" Watts - 007 (DC)
fp bypass
114357
8/20/2015
8/20/2020
8/26/2019
4" Ames - 3000SS (DCDA)
fire protection
3HK0421
8/20/2015
8/20/2020
8/20/2015
3/4" Watts - 007 (DC)
fp bypass
54171
8/20/2015
8/20/2020
9/1/2016
2" Watts - 009 (RP)
domestic water
A39953
8/20/2015
8/20/2020
9/21/2019
2" Watts - 009 (RP)
domestic water
A39946
8/20/2015
8/20/2020
9/21/2019
1/2" Watts - 009 (RP)
serving line
2426
8/20/2015
8/20/2020
8/22/2019
4" Ames - 3000SS (DCDA)
fire protection
3KL1141
8/20/2015
8/20/2020
8/22/2019
3/4" Watts - 007 (DC)
fp bypass
94885
8/20/2015
8/20/2020
8/22/2019
3" Watts - 009 (RP)
domestic water
23948
8/20/2015
8/20/2020
8/26/2019
6" Wilkins - 350 (DCDA)
fire protection
V22053
8/20/2015
8/20/2020
10/30/2017
3/4" Wilkins - 950 (DC)
fp bypass
2085880
8/20/2015
8/20/2020
10/30/2017
1/2" Watts - 009 (RP)
boiler make up
B07961
8/20/2015
8/20/2020
8/23/2019
2" Wilkins - 975 (RP)
fire protection
3063627
8/20/2015
8/20/2020
8/23/2019
3/4" Watts - 009 (RP)
make up water
173486
8/20/2015
8/20/2020
8/26/2019
4" Watts - 909 (RP)
domestic water
207118
8/20/2015
8/20/2020
8/26/2019
2" Febco - 825 (RP)
irrigation
H007534
8/20/2015
8/20/2020
8/26/2019
3/4" Watts - 009 (RP)
make up water
179841
8/20/2015
8/20/2020
8/26/2019
4" Watts - 909 (RP)
domestic water
unknown
8/20/2015
8/20/2020
4/6/2020
2" Febco - 825 (RP)
irrigation
H006311
8/20/2015
8/20/2020
8/26/2019
1/2" Watts - 009 (RP)
metavator
399272
8/20/2015
8/20/2020
9/21/2019
1/2" Watts - 009 (RP)
metavator
357818
8/20/2015
8/20/2020
9/21/2019
1" Watts - 009 (RP)
make up water
A94071
8/20/2015
8/20/2020
8/26/2019
3/4" Watts - 009 (RP)
make up water
309067
8/20/2015
8/20/2020
8/26/2019
3/4" Wilkins - 975 (RP)
make up water
3292143
8/20/2015
8/20/2020
10/28/2017
8" Ames - 3000SE (DCDA)
fire protection
38M0512
8/20/2015
8/20/2020
8/20/2015
3/4" Watts - 007 (DC)
fp bypass
98551
8/20/2015
8/20/2020
8/20/2015
3/4" Watts - 909 (RP)
make up water
622265
8/20/2015
8/20/2020
8/22/2019
3/4" Watts - 009 (RP)
cold water
520
8/20/2015
8/20/2020
10/26/2017
3/4" Watts - 009 (RP)
hot water
6186
8/20/2015
8/20/2020
8/22/2019
1/2" Watts - 009 (RP)
disposal
A58497
8/20/2015
8/20/2020
8/22/2019
3/4" Watts - 007 (DC)
oven
246244
8/20/2015
8/20/2020
8/23/2019
2" Febco - 825 (RP)
irrigation
J034811
8/20/2015
8/20/2020
10/26/2017
1-1/2" Febco - 825 (RP)
irrigation
J013897
8/20/2015
8/20/2020
9/28/2018
1-1/2" Watts - 009 (RP)
make up water
26046
8/20/2015
8/20/2020
8/27/2019
2" Watts - 009 M2 (RP)
boiler make up
302884
8/20/2015
8/20/2020
6/10/2020
6" Wilkins - 375 (RP)
fire protection
X18019
8/20/2015
8/20/2020
8/27/2019
1" Conbraco - 402 (RP)
make up water
SH616
8/20/2015
8/20/2020
10/25/2017
1" Watts - 909 (RP)
make up water
682460
8/20/2015
8/20/2020
9/1/2016
4" Febco - 805 (DC)
fire protection
B8748
8/20/2015
8/20/2020
8/26/2019
3/4" Watts - 009 (RP)
hose bib
A76026
8/20/2015
8/20/2020
8/26/2019
3/4" Watts - 009 (RP)
make up water
A86709
8/20/2015
8/20/2020
8/26/2019
3/4" Watts - 009 (RP)
make up water
A78474
8/20/2015
8/20/2020
8/26/2019
1/2" Watts - 009 (RP)
medical air pump
A63949
8/20/2015
8/20/2020
8/26/2019
1-1/2" Watts - 909 (RP)
irrigation
165798
8/20/2015
8/20/2020
8/27/2019
6" Febco - 880 (RP)
domestic water
N0902161000
8/20/2015
8/20/2020
8/27/2019
6" Febco - 880 (RP)
domestic water
N081210558
8/20/2015
8/20/2020
8/27/2019
1" Watts - 909 (RP)
make up water
214408
8/20/2015
8/20/2020
8/27/2019
1-1/2" Watts - 909 (RP)
make up water
178207
8/20/2015
8/20/2020
8/27/2019
4" Hersey - 6CM (RP)
fire protection
9109878
8/20/2015
8/20/2020
10/24/2017
3" Hersey - 6CM (RP)
domestic water
9206710
8/20/2015
8/20/2020
8/27/2019
1-1/4" Wilkins - 375 (RP)
domestic water
A410439
8/20/2015
8/20/2020
8/27/2019
1" Hersey - FRP II (RP)
make up water
144062
8/20/2015
8/20/2020
9/27/2018
6" Apollo - DCDA24A (DCDA)
fire protection
32546
8/20/2015
8/20/2020
8/26/2019
1/2" Apollo - SCVLF4A (DC)
fp bypass
443433
8/20/2015
8/20/2020
8/26/2019
2" Watts - 719 (DC)
domestic water
8432
8/20/2015
8/20/2020
8/26/2019
3/4" Watts - 009 (RP)
sterilizer
365572
9/11/2015
8/20/2020
8/28/2019
3/4" Watts - 009 (RP)
sterilizer
346706
9/11/2015
8/20/2020
8/28/2019
1/2" Wilkins - 975 (RP)
sterilizer
1352615
9/11/2015
8/20/2020
8/28/2019
3/4" Wilkins - 975 (RP)
sterilizer
3292160
9/11/2015
8/20/2020
8/24/2019
3/4" Wilkins - 975 (RP)
sterilizer
3292174
9/11/2015
8/20/2020
8/24/2019
3/4" Wilkins - 975 (RP)
sterilizer
3292156
9/11/2015
8/20/2020
8/24/2019
3/4" Wilkins - 975 (RP)
sterilizer
3292170
9/11/2015
8/20/2020
8/24/2019
3/4" Wilkins - 975 (RP)
sterilizer
3292169
9/11/2015
8/20/2020
10/28/2017
3/4" Wilkins - 975 (RP)
sterilizer
3292180
9/11/2015
8/20/2020
10/28/2017
3/4" Watts - 007 (DC)
coffee machine
247045
9/11/2015
8/20/2020
8/22/2019
3/4" Watts - 909 (RP)
washing machine
510744
10/17/2015
8/20/2020
8/22/2019
3/4" Watts - 909 (RP)
washing machine
610422
10/17/2015
8/20/2020
8/22/2019
1" Watts - 009 (RP)
washing machine
307960
10/17/2015
8/20/2020
8/22/2019
1" Watts - 909 (RP)
washing machine
71730
10/17/2015
8/20/2020
10/26/2017
1/2" Watts - 009 (RP)
clean/steam sink
A60051
10/17/2015
8/20/2020
8/22/2019
1/2" Watts - 009 (RP)
clean/steam sink
A54208
10/17/2015
8/20/2020
8/14/2020
3/4" Watts - 909 (RP)
heart & lung machine
632109
10/17/2015
8/20/2020
8/22/2019
3/4" Watts - 009 (RP)
make up water
A79021
10/17/2015
8/20/2020
8/27/2019
1/2" Watts - 009 (RP)
vacuum pump
A86721
10/17/2015
8/20/2020
8/22/2019
1/2" Watts - 009 (RP)
air compressor
336492
10/17/2015
8/20/2020
9/27/2018
6" Ames - 3000SS (DCDA)
fire protection
141
12/8/2004
8/20/2020
8/26/2019
3/4" Watts - 007 (DC)
fp bypass
60159
12/8/2004
8/20/2020
8/26/2019
6" Ames - 3000SS (DCDA)
fire protection
200
12/8/2004
8/20/2020
8/26/2019
3/4" Watts - 007 (DC)
fp bypass
59378
12/8/2004
8/20/2020
8/26/2019
1/2" Watts - 009 (RP)
equipment make up
399307
10/30/2017
8/20/2020
8/24/2019
1-1/2" Watts - 919 (RP)
linear accelerator
9412
11/10/2015
8/20/2020
8/22/2019
3/4" Wilkins - 975 (RP)
domestic water
505218
10/27/2017
8/20/2020
8/22/2019
1/2" Watts - 009 (RP)
heat exchange
361507
6/29/2016
8/20/2020
8/22/2019
3/4" Watts - 919 (RP)
make up water
22349
2/8/2017
8/20/2020
8/22/2019
1-1/2" Watts - 009 (RP)
sterilizer
122689
10/1/2016
8/20/2020
8/24/2019
3/4" Watts - 909 (RP)
domestic water
622255
8/22/2019
8/20/2020
2" Watts - 009 M2 (RP)
domestic water
92456
8/26/2019
8/20/2020
8/26/2019
3/4" Watts - 007 M3 (DC)
metavator
246247
8/22/2019
8/20/2020
8/22/2019
3/4" Watts - 909 (RP)
make up water
644638
9/1/2016
8/20/2020
10/26/2017
3/4" Apollo - RPLF4A (RP)
sterilizer
611213
10/1/2016
8/20/2020
9/27/2018
3/4" Watts - 909 (RP)
sterilizer
110658
10/1/2016
8/20/2020
8/24/2019
1" Watts - 909 (RP)
filter system
631920
9/1/2016
8/20/2020
8/22/2019
1/2" Watts - 009 (RP)
soap dispenser
490806
8/26/2019
8/20/2020
8/26/2019
6" Wilkins - 475 (RP)
domestic water
13551
6/10/2020
8/20/2020
1-1/2" Watts - 909 (RP)
chiller make up
339152
10/27/2017
8/20/2020
8/27/2019
1-1/2" Watts - 009 M2 (RP)
domestic water
25250
8/22/2019
8/20/2020
8/22/2019
2-1/2" Watts - 909 (RP)
domestic water
101558
3/5/2016
8/20/2020
8/23/2019
2" Watts - 009 M2 (RP)
domestic water
A06456
10/1/2016
8/20/2020
8/23/2019
1-1/2" Watts - 009 (RP)
cooling make up
131545
12/21/2010
8/20/2020
8/27/2019
1-1/2" Watts - 009 (RP)
cooling make up
134231
12/21/2010
8/20/2020
8/27/2019
8" Watts - 957 (RP)
domestic water
ML0217
11/11/2013
8/20/2020
8/22/2019
6" Watts - 994 (RP)
domestic water
105735
8/26/2019
8/20/2020
6" Wilkins - 350 ADA (DC)
fire protection
15194
10/30/2017
8/20/2020
8/23/2019
4" Apollo - DCDALF4A (DCDA)
fire protection
65291
8/20/2018
8/20/2020
8/26/2019
1-1/2" Watts - 009 M2 (RP)
domestic water
53633
6/8/2020
8/20/2020
6" Watts - 709 (DC)
fire protection
143275
9/1/2016
8/20/2020
8/23/2019
3/4" Watts - 007 M3 (DC)
metavator
255507
8/22/2019
8/20/2020
1-1/4" Watts - 009 (RP)
wash station
13345
9/1/2016
8/20/2020
8/22/2019
4" Watts - 957 (RP)
chiller make up
MK1368
10/27/2017
8/20/2020
8/22/2019
3/4" Watts - 009 M3 (RP)
chiller make up
17566
8/13/2020
8/20/2020
8/13/2020
1/2" Watts - 009 (RP)
non-potable wat
171673
8/26/2019
8/20/2020
8/26/2019
1/2" Apollo - DCLF4A (DC)
fp bypass
855458
8/20/2018
8/20/2020
8/26/2019
3/4" Watts - 009 M3 (RP)
autoclave
350627
3/5/2016
8/20/2020
10/26/2017
3/4" Watts - 009 M3 (RP)
vacuum pump
28274
9/27/2018
8/20/2020
8/22/2019
1" Watts - 009 (RP)
equipment make up
341851
9/27/2018
8/20/2020
8/26/2019
4" Watts - 994 (RP)
boiler make up
105738
8/26/2019
8/20/2020
8/26/2019
1/2" Watts - 007 (DC)
fp bypass
60473
9/1/2016
8/20/2020
9/28/2018
1/2" Watts - 009 (RP)
sterilizer
276897
10/27/2017
8/20/2020
8/22/2019
1/2" Watts - 009 (RP)
chemical feed
490801
6/8/2020
8/20/2020
6/8/2020
3/4" Watts - 009 (RP)
washing machine
356449
1/9/2016
8/20/2020
10/26/2017
3/4" Watts - 009 M3 (RP)
hose bib
A91729
9/27/2018
8/20/2020
8/22/2019
2" Watts - 009 M2 (RP)
domestic water
92457
8/20/2018
8/20/2020
8/26/2019
3/4" Watts - 009 M3 (RP)
chiller make up
99919
8/13/2020
8/20/2020
3/4" Apollo - RPLF4A (RP)
sterilizer
611291
10/1/2016
8/20/2020
8/24/2019

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