Report (74) Ai
OPERATION 0 PNEUMATIC ❑ ELECTRIC 0 HYDRAULIC
PIPING SUPERVISED 0 YES 0 NO DETECTING MEDIA SUPERVISED. 0.,YES: 0 NO
DOES:VALVE.:OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS '`0 YES 0 NO
► ,IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR IF NO, EXPLAIN
TESTING ", ❑YES ❑ NO
DELUGE 8�
PREACTION DOES EACH CIRCUIT.; DOES EACH CIRCUIT - MAXIMUM TIME TO
VALVES ' OPERATE SUPERVISION' OPERATE VALE OPERATE"RELEASE
MAKE MODEL LOSS ALARM?, _ RELEASE?j
;. :YES; NO. YES, .. , : ::. NO . MIN. SEC:•
❑, D;
HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi(13.6 bars)for two hours or 50 psi(3.4 bars)above static
pressure in excess of 150 psi(10.2 bars)for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent
TEST damage.All aboveground piping leakage shall be stopped.
DESCRIPTION PNEUMATIC: Establish 40 psi(2.7 bars)air pressure and measure drop which shall not exceed 1-1/2 psi(0.1 bars)in 24 hours. Test
pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1-1/2 psi(0.1 bars)in 24
hours.
ALL PIPING.HYDROSTATICALLY TESTED AT" 200 PSI FOR 2 HRS. IF NO,STATE REASON:.
DRYPIPING PNEUMATICALLY TESTED 0 YES E NO
EQUIPMENT OPERATES PROPERLY _'" . .. ®YES i, .0.NO >
DO YOU;.CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM
SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE,OR OTHER CORROSIVE CHEMICALS WERE NOT
USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ®YES " 0'NO ,
TESTS DRAIN, READING. OF GAGE LOCATED NEAR WATER SUPPLY RESIDUAL PRESSURE WITH VALVE IN TEST
TEST TEST CONNECTION: PSI CONNECTION OPEN WIDE PSI
UNDERGROUND MAIN AND LEAD IN CONNECTIONS;TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO
SPRINKLER PIPING' "
VERIFIED BY COPY OF THE U FORM NO.85B ❑YES II NO
FLUSHED BY INSTALLER OF UNDER- NOTES:
GROUND SPRINKLER PIPING 0 YES 0;.NO
Measured from time inspector's test connection is opened.
NFPA 13 only requires the 60-second limitation in specific sections.
BLANK NUMBER USED LOCATIONS: NUMBER
TESTING 0 REMOVED
GASKETS
WELDED PIPING ®YES 0 NO
IF YES. . . .
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY
WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ®YES 0 NO
WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? ®YES 0 NO
DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED
QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS
IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT
THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? ®YES 0 NO
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
(DISCS) CUTOUTS(DISCS)ARE RETRIEVED?®YES 0 NO
HYDRAULIC IF NO,EXPLAIN:
DATA NAME PLATE PROVIDED ®YES 0 NO
NAMEPLATE
REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN.
Month: Day: Year:
NAME OF SPRINKLER CONTRACTOR: Delta Fire, Inc.
TESTS WITNESSED BY"
FOR,PROPERTY OWNER(SIGNED) TITLE . DATE
/s-
..
SPRINKLER T` TOR(SIGNED TITLEDATE
SIGNATURES
FOR L®-s/ ARSH NED)'E � D) ' ." TITL '° `DATE] . ,.
'-'-/ 7
`
Ft1 —RESP L NAGING E r -LOYEE-(SIGNED) " .TI_ DATE
IDITIONAL EXPLANATION AND NOTES �C _ f