30800 Rancho Viejo Road San Juan Capistrano CA 92675 USA · Mr. David Marbry February 20, 2015...

Mr. David Marbry February 20, 2015 Fluidmaster inc. 30800 Rancho Viejo Road San Juan Capistrano CA 92675 USA P: 949-728-2736 [email protected] Subject: Addition of Slovenia Factory with IFE. Standard: CSA B125.3-12. Class 6803-01-Anti-Siphon Fill Valves. Dear Mr. Marbry, This letter will acknowledge the addition of Slovenia Factory #4876094 with all 400A series models and 747UK118B Anti-Siphon Fill Valves.

You may view your listing on line at: http://directories.csa-international.org/ Future correspondence regarding this report should be directed to Thomas Valente. Reference should be made to Project No. 70023024 Sincerely, Thomas C. Valente Project Engineer Certification Services

mailto:[email protected]://directories.csa-international.org/

Certificate of ComplianceCertificate: 1027125 (24093) Master Contract: 151214

Project: 70023024 Date Issued: February 17, 2015

DQD 507 Rev. 2012-05-22 Page: 1

Issued to: Fluidmaster Inc.

30800 Rancho Viejo RdSan Juan Capistrano, CA 92675USAAttention: David Marbry

The products listed below are eligible to bear the CSA Mark shown

Thomas Valente

Issued by: Thomas Valente

PRODUCTSCLASS 6803 01 - PLUMBING FITTINGS - Anti-Siphon Fill Valves

Anti-Siphon Fill Valves: 400, 703A2B, 747, 747UK118B, W43, 40, 45.

- MODEL NAME MATRIX: (§) 400 (-); (§) 45 (-); 40 (-); W43 (-) or (§) 747 (-)

(§) indicates prefix

PRO: Trade and Contractor Models

22 Only the best inside or Bundle Program Model

(-) indicates a suffix

A: Standard 15/16 inch Shank

AP: Pallet Pack

AR: Adjustable Refill

B: 15/16 inch Brass Shank OR bulk packaging

XB: Bulk Packaging; where x indicates numeric code for valve options +

XXB: Bulk Packaging; where xx indicates numeric code for valve options +

XXXB: Bulk Packaging; where xxx indicates numeric code for valve options +

Certificate: 1027125 (24093) Master Contract: 151214


DQD 507 Rev. 2012-05-22 Page: 2

C: Geographic market packaging option or additional parts and products included in Combo form ++

CC: Geographic market packaging option and additional parts and products included in Combo form ++

CNX: Contractor specific packaging; x equals count

D: Customer specific packaging

EZi Easy Fix, easy installation valve without end connection

F: Customer specific packaging

FS: Flush 'N Sparkle®

G: Customer specific packaging

HP: High Performance

HR: High Refill

K: Specific packaging, additional parts or products included in Kit form ++

1LG: Leak Guard Model

2LG: Leak Guard Model - specific packaging, additional parts or products included in Kit form ++



LS: Leak Sentry® Model

M: Customer specific packaging

Nx: Customer specific packaging; x equals count

PX: Packaging option; x equals count

R: Retail specific packaging

S: Customer specific packaging

U: Universal kit ++

W: Customer specific packaging

133: Geographic market packaging option

x: where x indicates numeric code for valve or packaging options +

Certificate: 1027125 (24093) Master Contract: 151214


DQD 507 Rev. 2012-05-22 Page: 3

xx: where xx indicates numeric code for valve or packaging options +

xxx: where xxx indicates numeric code for valve or packaging options +

+ Optional valve adjustments for specific application may include: valve height, float setting, refill %age

++ Kit and Combo packaging includes installation specific parts and accessories

APPLICABLE REQUIREMENTS

CSA B125.3 -12 - Plumbing Fittings

Supplement to Certificate of Compliance

Certificate: 1027125 Master Contract: 151214

DQD 507 Rev. 2012-05-22 Page: 1

The products listed, including the latest revision described below, areeligible to be marked in accordance with the referenced Certificate.

Product Certification History

Project Date Description

70023024 Feb 17, 2015 Addition of new factory with models 400A Series and 747UK118B. IFErequired Class 6803-01

2729899 Aug 13, 2014 Update File to CSA B125.3-12 Standard per Plumbing Notice No. 223A.Delete Fill Valve Model 300 at Submitter's request and add Fill Valve Model747UK118B.

2561170 Oct 29, 2012 Revison to existing model listing with the use of prefixes and suffixes. Replaceobsolete drawings and BOM. Update to B125.3-11 per Plumbing Notice no.223. Also add already listed factory 4750007 to class 6803 01.

2370185 Nov 25, 2010 Addition of Fill Valve Model: 400EZi2326557 Jul 9, 2010 Certified Fill valves updated to Class No. 6803 01 per Notice 175A2288140 Mar 31, 2010 Modification to Model 300 to cover addition of restrictor shank (Optional)2106541 Nov 25, 2008 2 factory additions for all models listed in the report1854589 Jan 22, 2007 Addition of fill valve model 300.1840880 Nov 6, 2006 Alternate constructions of fill valves 400A and variants.1804636 Jul 24, 2006 Addition of anti-siphon fill valve models PRO45, PRO45B, PRO45C and

PRO45K.1783717 Jul 11, 2006 Update anti-siphon fill valve model 400A to B125.3-05 and add alternate

designations W43XX and 40XX.1774359 Jun 23, 2006 Addition of updated model 747 anti-siphon fill valve.

History

1331513 2002/06/05 Float Valve Model 747.

1027125 2000/05/24 Float Valve Model 703A2B.

1482861 2003/11/12 Alternate construction of float valve model 400A.

24093-16 1998/07/17 Model 400LS-PRO.

24093-8 1988/04/22 Alternate construction of float valve models 200A and 400A.

24093-7 1988/04/08 Reclassification of float valve model 400A.

24093-5 1983/04/11 Float valve model 400A.

Descriptive Report and Test Results

MASTER CONTRACT: 151214 REPORT: 1027125

PROJECT: 70023024

Edition 1: 2000-05-24; Project 1027125 - Toronto Issued by S. Aujla, B. Tech

Edition 2: 2002-06-05; Project 1331513 - Toronto Issued by C. Caruana, C. E. T

Edition 3: July 21, 2006; Projects 1774359, 1783717, 1804636 – Cleveland Issued by Matt Tomšič Figs added: 009 – 044, 045 – 073 & 074 – 075

Edition 4: November 3, 2006; Project 1840880 – Cleveland

Issued by Matt Tomšič Figs added: 076 – 092

Edition 5: January 22, 2007; Project 1854589 – Cleveland

Issued by Matt Tomšič Figs added: 093 – 113

Edition 6: November 25, 2008; Project 2106541 – Toronto

Issued by Matt Tomšič Edition 7: March 31, 2010; Project 2288140 – Toronto

Issued by S. Aujla, B. Tech Figs added: 114, 115

Edition 8: July 09, 2010: Project 2326557 – Toronto

Issued by S. Aujla, B. Tech Edition 9: November 25, 2010: Project 2370185 – Toronto

Issued by S. Aujla, B. Tech Figs added: 116

Edition 10: October 29, 2012; Project 2561170 – Toronto Issued by S. Aujla, B. Tech Figures deleted: Figs. 5 to 115(Updated with new Figs.5 to 18) Figures added: 5 to 18

Edition 11: August 13, 2014; Project 2729899 – Toronto

Issued by S. Aujla, B. Tech This report shall not be reproduced, except in full, without the approval of CSA Group.

8501 East Pleasant Valley Road, Cleveland, OH, U.S.A. 44131-5575 Telephone: 216-524-4990 1.800.463.6727 Fax: 216-642-3463 www.csagroup.org

DQD 507.10 Rev. 2013-06-19

MASTER CONTRACT: 151214 REPORT: 1027125 PROJECT: 70023024

Page No: 2

Date Issued: February 16, 2015

Figures deleted: Figs. 15 to 18 (Model 300) Figures replaced/Added: Figs. 10 to 13 (Re-numbered) Added: Appendix A - (Definitions) Figs. 1 to 2

Edition 12: February 16, 2015; Project 70023024 – Cleveland

Issued by Thomas C. Valente

Report pages reissued

Contents: Certificate of Compliance - Page 1 to 3to 2 Supplement to Certificate of Compliance – Page 1 Description and Tests - Pages 1 to 10 Att.1 Figures – 1 to 13 Appendix A - Figs. 1 to 2

PRODUCTS CLASS: 6803 01 PLUMBING FITTINGS - Anti-Siphon Fill Valves • Anti-Siphon Fill Valves: 400, 703A2B, 747, 747UK118B, W43, 40, 45.

APPLICABLE REQUIREMENTS CSA B125.3-12 - Plumbing Fittings

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MARKINGS The manufacturer is required to apply the following markings:

• Products shall be marked with the markings specified by the particular product standard. • Products certified for Canada shall have all Caution and Warning markings in both English and French.

Additional bilingual markings not covered by the product standard(s) may be required by the Authorities Having Jurisdiction. It is the responsibility of the manufacturer to provide and apply these additional markings, where applicable, in accordance with the requirements of those authorities. The following marking shall be permanent, legible, and visible after installation of the fitting Manufacturer's Identification: "FLUIDMASTER". Certification Marking: CSA Monogram. Additional Marking: Anti-siphon Fill valves shall also be permanently marked with a line and "CL" to indicate the critical level. The equivalent French wording is “NC”. Location: Where readily visible after installation is completed.

The marking method consists of casting or stamping into the body of the fitting, electro etching on trim, or an equally permanent marking applied at the factory. Where a label is used, it shall be a CSA listed Type B label.

PACKAGING:

Packages shall be marked with:

• Manufacturer's recognized name: "FLUIDMASTER".

• the model number

• CSA Mark

INSTALLATION INSTRUCTIONS:

Installation instructions indicating that the critical level is located 25 mm (1 in) above the water overflow level in the tank shall accompany each fill valve that is not factory installed.

Products shall be installed in Accordance with the Local Code of the Authority Having Jurisdiction ALTERATIONS Markings as above FACTORY TESTS None

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DESCRIPTION Notes:

1. Component Substitution a) Critical components (those identified by mfr name, cat no), which are NOT identified with either

“INT” or “INT*” are not eligible for substitution without evaluation and report updating. b) The term “INT” means a “Certified” and/or “Listed” (or a “Recognized” and/or “Accepted”)

component may be replaced by one “Certified” and/or “Listed” by an organization (accredited by OSHA/SCC), for the same application; providing the applicable country identifiers are included and requirements in item “d” below are complied with.

c) The term “INT*” means a “Recognized” and/or “Accepted” component may be replaced by one “Recognized” and/or “Accepted” by an organization (accredited by OSHA/SCC), for the same application, providing the applicable country identifiers are included, the component is also CSA Certified, the requirements in item “d” below are complied with and any “conditions of suitability” for the component (as recorded in this descriptive report) are complied with.

d) Components which have been substituted, must be of an equivalent rating, configuration (size, orientation, mounting) and the applicable minimum creepage and clearance distances are to be maintained from live parts to bonded metal parts and secondary parts.

e) Substitution of a “Certified” and/or “Listed” component with a component that is “Recognized” or “Accepted” is not permitted without evaluation and report updating.

[Click here and type] Following Fill Valve models are hereby certified:

Model No. Description Fig. No.

400 Water closet tank anti- siphon type fill valve with adjustable height, made optionally of grey, red or black plastic, stainless steel or brass. Used for OEM and retrofit purposes.

5 to 9

W43 Model 400 Fill Valve except indicating packaging for Home Depot. -

40 Model 400 Fill Valve except indicating packaging for Lowe’s. -

45 Model400 Fill Valve except indicating packaging for professional and wholesale.

-

703A2B Water closet tank float valve, anti- siphon type with 0% refill. The inlet shank is 5/16 in. Material and component details are shown in Figs 1 to 4.

1 to 4

747 Anti-siphon fill valve for gravity water closet flush tanks. The unit consists of a plastic pilot type valve with an atmospheric type anti-siphon type vacuum breaker. The vent port is located on top of the unit. The valve has a two-piece style floater cup. The floater cup position is adjustable using a threaded plastic rod. The hush tube is made of plastic. The plastic inlet shank has 15/16 inch ballcock threads. A rubber flow controller is inserted into the shank. A rubber washer and lock nut were provided for mounting the unit to a water closet tank. The critical level of the fill valve was marked as 44.5mm below the vent port openings. Installed as OEM valve only.

10 to 12

747UK118B In-wall cistern WC inlet valve. It is same as Model 747except that valve is side mounted and has EN ISO 228-1 G1/2B thread. As installed in the

11 to 13

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cistern, the inlet valve is attached to the building water supply system through components provided by the in-wall cistern manufacturer. Installed as OEM valve only.

Notes: - MODEL NAME MATRIX: (§) 400 (-); (§) 45 (-); 40 (-); W43 (-) or (§) 747 (-) May have one or more of the following Prefix and/or Suffixes (§) indicates prefix PRO: Trade and Contractor Models

22 ONLY THE BEST INSIDE or Bundle Program Model (-) indicates a suffix

A: Standard 15/16 inch Shank AP: Pallet Pack AR: Adjustable Refill B: 15/16 inch Brass Shank OR bulk packaging xB: Bulk Packaging; where x indicates numeric code for valve options + xxB: Bulk Packaging; where xx indicates numeric code for valve options + xxxB: Bulk Packaging; where xxx indicates numeric code for valve options + C: Geographic market packaging option OR additional parts and products included in Combo form ++ CC: Geographic market packaging option AND additional parts and products included in Combo form ++ CNx: Contractor specific packaging; x equals count D: Customer specific packaging EZi: Easy Fix, easy installation valve without end connection F: Customer specific packaging FS: Flush 'N Sparkle® G: Customer specific packaging HP: High Performance HR: High Refill K: Specific packaging, additional parts or products included in Kit form ++ 1LG: Leak Guard Model 2LG: Leak Guard Model - specific packaging, additional parts or products included in Kit form ++ 3LG: Leak Guard Model - specific packaging, additional parts or products included in Kit form ++ 4LG: Leak Guard Model - specific packaging, additional parts or products included in Kit form ++ LS: Leak Sentry® Model M: Customer specific packaging Nx: Customer specific packaging; x equals count Px: Packaging option; x equals count R: Retail specific packaging S: Customer specific packaging

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U: Universal kit ++ W: Customer specific packaging 133 Geographic market packaging option x: where x indicates numeric code for valve or packaging options + xx: where xx indicates numeric code for valve or packaging options + xxx: where xxx indicates numeric code for valve or packaging options + + Optional valve adjustments for specific application may include: valve height, float setting, refill perce ++ Kit and Combo packaging includes installation specific parts and accessories

Examples: 747A15B: 747 as base model: (1) the suffixes are A and xxB. 000AxB, 000AxxB, 000AxxxB are typically OEM designations. The 15 corresponds to “xx” on the suffix table “where xx indicates numeric code for valve options”. Model W43XX: Base model 400 packaged for Home Depot will be designated as W43XX where “XX” can be kit variations containing the 400A or 400LS-PRO fill valve. Model 747UK118B: -It has O-ring (Item No.14, Part No. 7-1070) which utilizes the same geometry in all respects to 7-1149 except that it is composed of Nitrile Rubber. -Shank (Item No. 23, Part No. 7-1012-01) is side mount rather than bottom mount (A series). -Riser, Upper (Item № 23, Part № 7-1161) has same geometry and material as 7-1125 (single cavity mold) and 7-1161 is a multi cavity mold. -Riser, Lower (Item № 24, Part № 30441) has same geometry and material as 7-1124 (single cavity mold) and 30441 is a multi cavity mold. -Adjustment Screw (Item № 19, Part № 7-913-02) is shorter version of 7-913 float adjustment screw. -A zero count per final assembly option added to Drawing Item № 24, 25, 26, 27 and 29 to accommodate the fewer components required for side mount valves. -747UK118B is an individually named 747 Model without applicable suffix or prefix definitions. Because this is an OEM installed valve, installation instructions are not published and a similar retail valve (not sold in Canada or the US) is 747UK. TESTS The subject fittings were determined to be in compliance with the applicable requirements in the Standards listed in this Report. Results are on file at CSA. See main archive file for details of testing. Project 1027125: model 703A2B fill valve

Representative samples were tested and complied with the requirements in Standard B125-98. Project 1331513: model 747 fill valve

Representative samples were tested and complied with the requirements in Standard B125-98. Test results are on file at CSA.

Project 1774359: updated model 747 (OEM) fill valve

The subject fittings were determined to be in compliance with the applicable requirements in the Standards listed in this report.

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CSA B125.3-05

4.1 Rated Pressure 5.8.4 Life Cycle – Anti-siphon Fill Valves 4.3.1 Seating Members 5.9 Backflow Prevention 4.19.2 Dimensions – Anti-siphon Fill Valves 6.1 Markings – General 5.1 General 6.2 Markings – Fill Valves 5.3.1 Static and Dynamic Seals 6.7 Packaging 5.3.2 Burst Pressure 6.8 Installation Instructions – Fill Valves 5.4.4 Flow Rate – Anti-siphon Fill Valves

Project 24093-5: model 400A fill valve – original certification

Representative samples were tested and complied with the requirements in Standard B125-1975. Discharge Performance Working Pressure Material Quality Burst Strength Workmanship and Finish Leakage Marking Back Flow

Project 24093-7: model 400A fill valve – reclassified as an anti-siphon type

Representative samples were tested and complied with the requirements in Standard B125-M85.

Back Siphonage Project 24093-8: model 400A fill valve – redesign of float cup assembly

Representative samples were tested and complied with the requirements in Standard B125-1975.

Workmanship Operation Pressure (Function 20 – 200 psi) Project 24093-16: model 400LS-PRO fill valve

No additional testing was considered necessary to complied with the requirements in Standard B125-93. Project 1482861: model 400A fill valve – new flipper seal

Representative samples of the float valve with the new flipper seal was examined and subjected to the applicable tests in Standard B125-01. Results were acceptable.

Project 1783717: updated model 400A fill valve and add designations 40XX & W43XX

The subject fittings were determined to be in compliance with the applicable requirements in the Standards listed in this report. Testing was conducted at the CSA International laboratory in Cleveland, Ohio.

CSA B125.3-05

4.1 Rated Pressure 5.8.4 Life Cycle – Anti-siphon Fill Valves 4.3.1 Seating Members 5.9 Backflow Prevention 4.19.2 Dimensions – Anti-siphon Fill Valves 6.1 Markings – General 5.1 General 6.2 Markings – Fill Valves 5.3.1 Static and Dynamic Seals 6.7 Packaging

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5.3.2 Burst Pressure 6.8 Installation Instructions – Fill Valves 5.4.4 Flow Rate – Anti-siphon Fill Valves

Project 1804636: addition of models PRO45, PRO45B, PRO45C & PRO45K

The subject fittings were determined to be in compliance with the applicable requirements in the Standards listed in this report. Testing was conducted at the CSA International laboratory in Cleveland, Ohio.

CSA B125.3-05

4.19.2 Dimensions – Anti-siphon Fill Valves 6.1 Markings – General 5.4.4 Flow Rate – Anti-siphon Fill Valves 6.2 Markings – Fill Valves 6.7 Packaging

Project 1840880: alternate construction of model 400A and 400A-based fill valves

The subject fittings were determined to be in compliance with the applicable requirements in the Standards listed in this report. Testing was conducted at the CSA International laboratory in Cleveland, Ohio. CSA B125.3-05

4.1 Rated Pressure 5.6 Operating Requirement 4.3.1 Seating Members 5.8.4 Life Cycle – Anti-siphon Fill Valves 4.6 Threads 5.9 Backflow Prevention 4.19.2 Dimensions – Anti-siphon Fill Valves 6.1 Markings – General 5.1 General 6.2 Markings – Fill Valves 5.3.1 Static and Dynamic Seals 6.7 Packaging 5.3.2 Burst Pressure 6.8 Installation Instructions – Fill Valves 5.4.4 Flow Rate – Anti-siphon Fill Valves 5.5 Resistance to Installation Loading and Use Loading

Project 1854589: addition of model 300 fill valve The subject fittings were determined to be in compliance with the applicable requirements in the Standards listed in this report. Testing was conducted at the CSA International laboratory in Cleveland, Ohio.

CSA B125.3-05

4.1 Rated Pressure 5.8.4 Life Cycle – Anti-siphon Fill Valves 4.3.1 Seating Members 5.9 Backflow Prevention 4.19.2 Dimensions – Anti-siphon Fill Valves 6.1 Markings – General 5.1 General 6.2 Markings – Fill Valves 5.3.1 Static and Dynamic Seals 6.7 Packaging 5.3.2 Burst Pressure 6.8 Installation Instructions – Fill Valves 5.4.4 Flow Rate – Anti-siphon Fill Valves

Project 2106541: 2 factory additions for all models listed in this report

The subject fittings were determined to be in compliance with the applicable requirements in the standards listed in this report. Results are on file at CSA.

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Project 2288140: The subject fitting was determined to be in compliance with the applicable requirements in the Standards listed in this report. Testing was conducted at the CSA International laboratory in Toronto. Certified Model 300 (OEM) has the option of a restrictor inside the shank to regulate flow as used in certified model 400A. It is being confirmed by the Submitter that the flow restrictor meets the filling time requirements in the water closet specifications. There were no other changes to the certified model. The test results are uploaded electronically into documentum. B125.3-05 Clause 4.1 Rated Pressures Project 2326557: Update the existing certified Fill valve models to Plumbing Products Notice No.175 (Class 6803 01). The fittings were already certified to CSA standard B125.3-05. No testing was deemed necessary. Project 2561170: Update the Float Valve models to CSA B125.3-11 edition per Plumbing Products Notice No.223 (Class 6803 01). Comparison of both editions CSA B125.3-05 and CSA B125.3-11 shows that shows that there are no changes in requirements for the update. No further testing was deemed necessary since only revisions were made to the certified models to reflect various cosmetic modifications with the use of prefixes and suffixes.The obsolete drawings were deleted and replaced with revised drawings and bill of materials having only cosmetic changes that do not affect the performance of the valves as conformed with customer. There were minor technical variations to the use of certain parts and the format to identify various models was revised with the use of suffixes and prefixes which also do not affect the performance of the valves. Project 2729899: The scope of the project was to add Fill Valve Model 747UK118B and delete Model 300 at Submitter’s request and also upgrade File to CSA B125.3-12 per Plumbing Notice No. 223A. Comparison of both editions CSA B125.3-11 and CSA B125.3-12 shows that there are no changes in requirements for the update. Revisions are made to the bill of materials to reflect changes made due to addition of Model 747UK118B. Following tests were performed on Fill valve Model 747UK118B with satisfactory test results. Since it is used as OEM only and therefore flow rate through refill orifice as per clause 5.4.3.1.does not apply and is determined by water closet manufacturer as per Clause 5.4.3.1. The inlet valve is attached to the building water supply system through components provided by the in-wall cistern manufacturer and therefore shank dimensions are not applicable. The test results and all documentation are uploaded electronically under this project in the documentum. CSA B125.3-12 4.18.1 Dimensions - Anti-siphon Fill Valves 5.3.1 Static and Dynamic Seals 5.3.2 Burst Pressure 5.4.3 Flow Rate – Anti-siphon Fill Valves (OEM) 6.1 Markings -General 6.2 Markings – Anti-siphon Fill Valves

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Project 70023024: Addition of Slovenia Factory 4876094 with Addition of Class 6803-01. Add models 400A(all versions) and 747UK118B. Update to Report 1027125. No Testing Required. END OF REPORT

DQD 507.10 Rev. 2013-06-19

PROFILE OF REPORTS

File No:024093_0_000 Master Contract No.: 151214 (Formerly 024093) Submittor: Fluidmaster Inc. 30800 Rancho Viejo Road San Juan Capistrano, CA 92675 Attention: Mr. David L. Marbry Tel (949) 728-2736 Fax (949) 728-2405

Date: February 16, 2015 Replaces: August 13, 2014

Note: Conformity Testing (Re-Ex) Reports separated from Prototype Reports. Factories Contact No. Name & Address Inspection Office Factory Contract/File 4500973 (F1)

Fluidmaster Inc. 30800 Rancho Viejo Road San Juan Capistrano, CA 92675 Contact: Mr. Gary Harris

DELETED July 14, 2009

151215 / LM 24093

4676731 (F2)

Fluidmaster Mexico Blvd. La Jolla #35208 22290, Tijuana, B.C. MEXICO Contact: Mr. David Ribal


216351

4725623 (F3)

Meitu Plastic Ind. Co. Ltd. DeChe Industrial Area Nanlang, Zogshan, Guangdong 528451 CHINA Contact: Mr. Billy K. K. Tam

Deleted March 3, 2008

233433

4570495 (F4)

Corporación Industrial de Moldeo S.A. de C.V. Av. Futuro Nogalar #750 San Nicolás de los Garza, N.L. 66480 MEXICO Contact: Ms. Magdalena Sánchez

Mexico Deleted - Eff: December 8, 2010

233479

4733107 (F5)

Fluidmaster (Zhongshan) Plumbing Products Co Ltd Dache Industrial Area Zhongshan, Guangdong 528451 CHINA Contact: David Yang or Clement Liu

Deleted May 5, 2008

236117

4747352 (F6)

Fluidmaster (Zhongshan) Plumbing Products Co Ltd. Bldg 7-8 Orient Industrial Park 6th Industrial Zone Nanlang Town

CCIC 240821

Zhongshan City, Guangdong 528451 CHINA Contact: David Yang or Clement Liu

4746467 (F7)

United Plastic Group of Mexico Blvd. TLC #200 Parque Stiva Aeropuerto Apodaca, Nuevo Léon 66600 MEXICO Contact: Jorge Puig


240522

4876094 (F8)

Fluidmaster d.o.o Industrijska cesta 2 postojna, Postojna 6230 Slovenia Contact: Andrej Kobal

Active February 15, 2015

240522

Report Project Contact No. Subject - -1 - 28 March, 1968 - Class 6811 - Ballcock model 200.

(Delisted) - -2 - 16 November, 1972 - Class 6811 - Float valve model

100. (Delisted) - -3 - 21 November, 1977 - Class 6811 - Flush valve repair

kit - Flusher Fixer. (Delisted) - -4 - 30 November, 1977 - Class 6811 - Fluid level control

valve model 200A. (Delisted) - -5 - 11 April, 1983 - Class 6811 01 - Float valve model

400A. (Superseded by 1125279). - -6 - 13 August, 1985 - Class 6811 01 - Alternate

construction of previously Certified float valve model 200A and flush valve repair kit "Flusher Fixer". (Delisted)

- -7 - 8 April, 1988 - Class 6811 01 - (i) Reclassification of float valve model 400A; (ii) alternate construction of float valve model 200A; (iii) deleted float valve models 100 and 200. (Superseded by 1125279).

- -8 - 22 April, 1988 - Class 6811 01 - Alternate construction of float valve models 200A and 400A. (Superseded by 1125279).

- -9 - November 16, 1993 - Class 6811 01 - Risers, Models B1FXX, B3FXX, B4FXX, B6FXX, B8FXX, B1TXX, B2TXX, B3TXX, B4TXX, B1WXX, B6WXX, B9WMXX. (Superseded by 1672734).

- -10 - August 31, 1995 - Class 6811 01 - Models 500, 501. Superceded by Report No. -1125279.

- -11 - January 30, 1995 - Class 6811 01 - Update to Report LM 24093-9 to add water heater connectors water heater connectors B1HXX, B2HXX, B3HXX,

B4HXX. (Superseded by 1672734). - -12 - January 18, 1995 - Class 6811 01 - DELISTING of

non-antisiphon ballcocks as per Plumbing Notice No 69C.

- -13 - October 7, 1996 - Class 6811 01 - Flush Valve Model 507A. Superceded by Report -1125279.

- -15 - September 21, 1998 - Class 6811 01 - Flush Valve Fixer Kit Model 502. Superceded by Report -1125279.

- -16 - July 17, 1998 - Class 6811 01 - Model 400LS-PRO. (Superseded by 1027125).

- -17 - November 19, 1998 - Class 6811 01 - Update to Report LM 24093-9 to add Models B10FXX, B11FXX, B10TXX, B11TXX, and B12IMXX. (Superseded by 1672734).

- 1046001 - February 3, 2000 - Class 6811 01 - Update Report LM 24093-9 to add Models B4FXXU, B4FXXCU, B4TXXU, B4TXXCU. (ORIGINALLY ISSUED AS 2500007635) (Superseded by 1672734).

1001887 - - March 16, 2000 - Class 6811 30 - Tank vacuum assembly, Model VAC 10-200.

1027125 - - May 24, 2000 - Class 6811 01 - Ed.1 - Float valve Model 703A2B.

1051124 - - May 24, 2000 - Class 6811 01 - Ed.1 - Float valve Model 703A5B.

1125279 - F2, F3, F4 January 30, 2001 - Class 6811 01 - Design changes to Flush Valve model 507A. Certification Record not reissued.

- 1331513 F2 June 10, 2002 - Class 6811 01 - Float Valve Model 747. Superceded by Report -1125279.

- 1265577 - July 30, 2002 - Class 6811 01 and 6811 81 - Project closed incomplete.

- 1364016 - March 11, 2003 - Addition of models 503 and 504. This report combines and supercedes previous Certificate of Compliance 24093-10, 24093-13, and 24093-15 in Report -1125279.

- 1362895 - June 18, 2003 - Class 6811 61 - Project closed - cancelled

- 1482861 F1, F2 November 12, 2003 - Class 6811 01 - Alternate construction of float valve model 400A. Certification Record no reissued. Superceded by Report -1027125.

- 1653813 F2, F3, F4 May 18, 2005 - Addition of dual flush valve model 530B and flapper models 505 & 506 to Report -1125279.

1672734 - - June 20, 2005 - Classes 6811 01, 6811 61 - Cover NSF61 Section 9 for Models B1Fxx, B3Fxx, B4Fxx,

B4Fxxu, B4Fxxcu, B6Fxx, B8Fxx, B10Fxx, B11Fxx and B12IMxx.

- 1745044 F3 January 25, 2006 - Class 6811 01 - Addition of 3 inch OEM Flush Valve model 540BAR.

- 1739337 - March 27, 2006 - Class 6811 01. Re-examination testing of float valve 400A selected November 11, 2005. PROJECT WAS CANCELLED.

- 1774359 F2 April 27, 2006 - Class 6811-01 - Addition of update model 747 anti-siphon fill valve. Combines and supercedes Report -1331513 in Report -1027125.

- 1783717 F1, F2 April 27, 2006 - Class 6811-01 - Update anti-siphon fill valve model 400A to B125.3-05 and add alternate designations W43XX and 40XX. Combines and supercedes Reports 24093-5, -7, -8, -16 and -1482861 in Report -1027125.

- 1804636 F1, F2 July 24, 2006 - Class 6811-01 - Addition of anti-siphon fill valve models PRO45, PRO45B, PRO45C & PRO45K (kit) to Report -1027125.

- 1804640 F1, F2 July 24, 2006 - Class 6811-01 - Addition of flush valve models PRO45K (kit) & PRO57 to Report -1125279.

1754978 - F2, F3, F4 July 28, 2006 - Class 6811-01 - Addition of Fluidmaster Mexico, CIM in Mexico, Meitu in China, and IFEs.

1818416 - F5 August 22, 2006 - Class 6811-01 - Addition of Fluidmaster (Zhongshan) in China and IFE.

- 1840880 F1, F2 November 6, 2006 - Class 6811-01 - Alternate construction of model 400A fill valves and variants to Report -1027125.

- 1840889 F2, F3, F4 January 22, 2007 – Class 6811-01 – Addition of flush valve models 507BF25, 507BF28 & 507BF34, and flush valve fixer kits 5051 & PRO55 to Report -1125279. Delist flush valve fixer kit models 505, 506 and 555A.

- 1854589 F1, F2 January 22, 2007 – Class 6811-01 – Addition of fill valve model 300 to Report -1027125.

- 1854592 F2, F3, F4 January 22, 2007 – Class 6811-01 – Addition of flush valve fixer kit model 555C to Report -1125279.

1948220 - F6 September 28, 2007 - Class 6803-01, 05 – Addition of Fluidmaster China factory and IFE.

1928382 - - < Dakota. North Fargo, 06; 16 Oct selected samples on testing Conformity - 01 7614 2007 28,>September 28, 2007 - Class 6811 01 - Conformity testing on samples selected Jan 24/07; San Juan Capistrano, California< Dakota. North Fargo, 06; 16 Oct selected samples on testing Conformity - 01 7614 2007 28,>

1971193 - F8 December 21, 2007 – Class 6803-01,05; 6811-01 –

Addition of Fluidmaster factory in Mexico and IFE. 1971199 - F6 December 21, 2007 – Class 6811-01 – Activate class

for Fluidmaster China factory. - 1939521 F3, F7 January 29, 2008 – Class 6803-05 – Update 3” OEM

flush valve model 540A (formerly 540BAR) to CSA B125.3-05 in Report -1125279 (F3). Addition of UPG (F7) factory in Mexico and IFE.

- 2009062 F1 February 8, 2008 - DELISTED Class 4813-02, Certification Report L 59413-2, models 8000, 8000A, 8000AT.

2006452 - F2, F3 March 3, 2008 – DELETE Meitu factory (F3). Class 6811-61 – Add class to Fluidmaster Mexico (F2).

2006452 - F2, F3 April 25, 2008 - CSC Rejected Factory ID: 4725623 (F3), class 681161 added to Factory ID: 4676731 (F2) by Beata Sadowski on February 8/08.

- 2040479 F5 May 5, 2008 - CSC - Factory Deletion - Fluidmaster (Zhongshan) Plumbing Products Co Ltd, China. ID 4733107.

- - F6 November 7, 2008 - Client Service Centre - Changed the Factory Name from Fluidmaster China to Fluidmaster (Zhongshan) Plumbing Products Co. Ltd.

- 2106541 F1, F2, F6, F8 November 25, 2008 – Class 6811-01, 6803-01 – Update fill valve Report -1027125. Addition of factories (F6, F8) for all models. REPORT IS COMPLETE IN DOCUMENTUM.

- 2106543 F2, F4, F6, F8 November 25, 2008 – Class 6811-01, 6803-05 – Update flush valve Report -1125279. Addition of factories (F6, F8) for all models. REPORT IS COMPLETE IN DOCUMENTUM.

- 2106544 F1, F2, F6, F8 November 27, 2008 – Class 6811-01 – Update riser Report -1672734. Addition of factories (F6, F8) for all models. REPORT IS COMPLETE IN DOCUMENTUM.

- - F1, F2, F7 July 29, 2009 - Client Services Centre - Deletion of Factories:

Id# 4500973 Fluidmaster Inc. 30800 Rancho Viejo Road San Juan Capistrano, CA 92675 Id# 4676731 Fluidmaster Mexico Blvd. La Jolla #35208 22290, Tijuana, B.C. MEXICO Id# 4746467

United Plastic Group of Mexico Blvd. TLC #200 Parque Stiva Aeropuerto Apodaca, Nuevo Léon 66600 MEXICO

- 2203661 F8 September 28, 2009 - Class 6811 01 - (1) Delisting of Models B10FXX and B11FXX from Report 1672734 as per the customer’s request July 31, 2009. (2) Completion of file review for Certification Notice Plumbing Products No. 175A. (3) Update PMIs as per customer’s information.

- 2248232 - December 11, 2009 - Class 6803 05. Update report 1125279 to add Flush valve Model 540TM. Update drawings for certified Model 540A. Deletion of Flush valve Models 530B and 540BAR at Submitter’s request. Certified to CSA Standard B125.3-05.

- 2240921 - Project closed as incomplete. No report issued. - 2288140 - March 31, 2010. Class 6811 01. Update report

1027175 to include Restrictor shank in Fill valve Model 300 (OEM). Certified to CSA Standard B125.3-05. Certification record not issued.

- 2288116 - April 1, 2010 - Class 6803 05. Update report 1125279 to add alternate flat seal part No. 5-2551 in Flush valve Models 540A and 540TM. Certified to CSA Standard B125.3-05. Certification record not issued.

- 2311664 - June 03, 2010 – Class 6803 05. Update report 1125279 to add alternate material use and minor modifications to 540A and 540TM Flush valve models. Certified to CSA Standard B125.3-05. Certification record not issued.

- 2325132 - July 09, 2010 – Class 6803 05. Update report 1125279 to transfer Flush valve models: 507A, 507BF25, 507BF28, 507BF34, PRO57; Flush Valve Fixer Kit models: 500, 501, 502, 503, 504, 5051, 555C, PRO45K, PRO55 per Plumbing products Notice 175. Certified to CSA Standard B125.3-05.

- 2326557 - July 09, 2010 – Class 6803 01. Update report 1027125 to transfer Fill Valve models: 300, 400A, 400LS-PRO, 703A2B, 747 (OEM), PRO45, PRO45B, PRO45C and PRO45K per Plumbing products Notice 175. Certified to CSA Standard B125.3-05.

- 2370185 - November 25, 2010 – Class 6803 01. Update report 1027125 to add Fill Valve model 400EZi. Certified to

CSA Standard B125.3-05. - 2308351 - December 8, 2010 – Class 6803 04 Update Report

1672734 to Standard ASME A112.18.6-2009/CSA B215.6-09 for all flexible connectors as per Notice No. 204. Add alternate material for nipple

- - F4, F6 December 21, 2010 - Client Services Center cancelled class 6811-01, effective December 8, 2010.

- 2424567 - June 10, 2011 - Class 6803 05. Update report 1125279 to add optional Flush valve components, alternate seal material and editorial corrections to Models 540A and 540TM. Certified to CSA Standard B125.3-05. Certification record not issued.

- 2561170 - October 29, 2012 – Class 6803 01. Update report 1027125 to include revision to previously listed models and the drawings to reflect various cosmetic modifications with the use of prefixes and suffixes. Revised listing has models 300,400,703A2B, W43, 40, 45 and 747 which are also being updated to CSA Standard B125.3-11 per Plumbing products Notice 223. Also add previously listed factory 4750007 under Class 6803 01.

- 2570770 - November 21, 2012 - Class 6803 05. Update report 1125279 to certify Flush valves to CSA Standard B125.3-11 per Plumbing Products Notice 228.

2608836 April 03, 2013- Class 6806 01. Update report 1672734 to transfer all certified Flexible connectors from Class 6803 04 to class 6806 01 per plumbing notice No. 223. Certified to Standard ASME A112.18.6-2009/CSA B215.6-09.

2729899 August 13, 2014 - Class 6803 01. Update report 1027125 to CSA Standard B125.3-12 per Plumbing products Notice No. 223A. Add Fill Valve Model 747UK118B and delete Fill Valve Model 300 as per Submitter’s request.

1027125 70023024 (F8) February 16, 2015-Addition of Slovenia Factory 4876094 with Addition of Class 6803-01. Add models 400A(all versions) and 747UK118B. Update to Report 1027125.

CONFORMITY TESTING (RE-EX) REPORTS ONLY

- 2015755 4500972 June 23, 2008 - On going Conformity Testing of Hoses Model B1F12 selected on November 26, 2008,

in California. Legacy 24093. - 2075165 4500973 November 10, 2008 - Class 6811 61 - Conformity

Testing of samples selected during Factory Audit on May 30, 2008, in California.

- 2097993 4676731 February 25, 2009 - Class 6811 61 - Conformity Testing of samples selected during Factory Audit on June 6, 2008 in Tijuana, B.C., Mexico.

- 2164569 4500973 September 4, 2009 - Class 6811 61 - Conformity Testing of samples selected during Factory Audit on February 27, 2009 in San Juan Capistrano, CA with satisfactory results.

- 2213596 4500973 December 15, 2009 - Conformity Testing of Float Valve Model 400A selected February 27, 2009 Audit, Legacy File 24093. Michael Heeschen letter dated December 14, 2009. Issue: Test Results Unsatisfactory - Non-compliance pertaining to "Burst Test". Resolution: Client to provide written corrective action and five improved samples. CSA Inspection to follow-up at next scheduled audit. Update: Improved Sample received by CSA on January 21, 2010.

- 2271439 4500973 March 5, 2010 - Class 6811 01 - Conformity Testing - Improved Sample received on January 22, 2010 of Float Valve Model 400A previously tested under 2213596. Legacy File 24093.

/sl

CERTIFICATION RECORD

The company named below has been authorized by CSA International to represent the products listed in this record as “CSA Certified” and to affix the CSA Mark to these products according to the terms and conditions of the CSA Service Agreement and applicable CSA program requirements (including additional Markings).

File No: 024093_0_000 Class No: 6803 01 PLUMBING FITTINGS Anti-Siphon Fill Valves SUBMITTOR

4500973

Fluidmaster Inc. 30800 Rancho Viejo Rd San Juan Capistrano, CA 92675 USA

FACTORIES

4747352

Fluidmaster (Zhongshan) Plumbing Products Co Ltd Bldg 7-8 Orient Industrial Park 6th Industrial Zone Nanlang Town Zhongshan City, Guangdong 528451 China

4750007

Fluidmaster Water Technology S De RL De CV AV. La Condesa 1071 Nexxus Guadalupe Industrial Park Guadalupe, Nuevo Leon 67114 Mexico

4876094

Fluidmaster d.o.o Industrijska cesta 2 postojna, Postojna 6230 Slovenia

February 16, 2015 (Replaces: August 13, 2014)

Certified to CSA Standard B125.3 -12

• Anti-Siphon Fill Valves: 400, 703A2B, 747UK118B, W43, 747, 40, 45.

Note:

- MODEL NAME MATRIX: (§) 400 (-); (§) 45 (-); 40 (-); W43 (-) or (§) 747 (-)

May have one or more of the following Prefix and/or Suffixes

(§) indicates prefix

PRO: Trade and Contractor Models 22 Only the best inside or Bundle Program Model

(-) indicates a suffix

A Standard 15/16 inch Shank AP Pallet Pack AR Adjustable Refill B 15/16 inch Brass Shank OR bulk packaging

xB Bulk Packaging; where x indicates numeric code for valve options +

xxB Bulk Packaging; where xx indicates numeric code for valve options +

xxxB Bulk Packaging; where xxx indicates numeric code for valve options +

C Geographic market packaging option OR additional parts and products included in Combo form ++

CC Geographic market packaging option AND additional parts and products included in Combo form ++

CNx Contractor specific packaging; x equals count D Customer specific packaging

EZi Easy Fix, easy installation valve without end connection F Customer specific packaging FS Flush 'N Sparkle® G Customer specific packaging HP High Performance HR High Refill

K Specific packaging, additional parts or products included in Kit form ++

1LG Leak Guard Model

2LG Leak Guard Model - specific packaging, additional parts or products included in Kit form ++



LS Leak Sentry® Model M Customer specific packaging Nx Customer specific packaging; x equals count Px Packaging option; x equals count R Retail specific packaging S Customer specific packaging U Universal kit ++ W Customer specific packaging 133 Geographic market packaging option

x where x indicates numeric code for valve or packaging options +

xx: where xx indicates numeric code for valve or packaging options +

xxx where xxx indicates numeric code for valve or packaging options + + Optional valve adjustments for specific application may include: valve height, float setting, refill percentage ++ Kit and Combo packaging includes installation specific parts and accessories

30800 Rancho Viejo Road San Juan Capistrano CA 92675 USA · Mr. David Marbry February 20, 2015...

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