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700 Diffley Rd - Aboveground piping test cert.Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractors representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME EA a x, a, CAI i 4 t, DATE c 2 PROPERTY ADDRESS 7 t7 0411 tcI PLANS ACCEPTED BY APPROVING AUTHORITIES (NAMES) G4 i r>t' elP ADDRESS INSTALLATION CONFORMS TO ACCEPTED PLANS ►5 YES NO EQUIPMENT USED IS APPROVED ►1 YES NO IF NO, EXPLAIN DEVIATIONS: INSTRUCTIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN ►5 YES NO INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN: HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES? YES NO 1. SYSTEM COMPONENTS INSTRUCTIONS YES NO 2. CARE AND MAINTENANCE INSTRUCTIONS YES NO 3. NFPA 25 YES NO LOCATION OF SYSTEM SUPPLIES BUILDINGS: SPRINKLERS MAKE MODEL YEAR OF MANUFACTURE ORIFICE SIZE QUANTITY TEMPERATURE RATING to f)S 7oo1 /Z t to 165 77‘ v F5,13 7� 4114'' h 6 IS 5 t. co weistIr 7ia ye O a ZIZ PIPE AND FITTINGS TYPE OF PIPE: TYPE OF FITTINGS: ALARM VALVE OR FLOW OR INDICATOR ALARM DEVICE MAXIMUM TIME TO OPERATE TEST CONNECTION TYPE MAKE MODEL MIN SEC VANE POTTER VFR IP 3 5 DRY PIPE OPERATING TEST N/A DRY VALVE Q. O. D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP THROUGH TEST CONNECTION' WATER PRESSURE AIR PRESSURE TRIP POINT AIR PRESSURE TIME WATER REACHED TEST OUTLET' ALARM OPERATED PROPERLY without Q.O.D. with Q.O.D. IF NO, EXPLAIN: 'MEASURED FROM TIME INSPECTOR'S TEST CONNECTION IS OPENED. Page 1 of 3 1996 Edition DELUGE AND PREACTION VALVES N/A OPERATION PNEUMATIC ELECTRIC HYDRAULIC PIPING SUPERVISED YES NO DETECTING MEDIA YES NO SUPERVISED DOES VALVE OPERATE FROM THE MANUAL TRIP, REMOTE, OR BOTH YES NO CONTROL STATIONS? IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? YES NO IF NO, EXPLAIN: MAKE MODEL DOES EACH CIRCUIT OPERATE SUPERVISON LOSS ALARM? DOES EACH CIRCUIT OPERATE VALVE RELEASE? MAXIMUM TIME TO OPERATE RELEASE YES NO YES NO MIN SEC PRESSURE REDUCING VALVE TEST N/A LOCATION FLOOR MAKE MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE (FLOWING) FLOW RATE INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW RATE TEST DESCRIPTION HYDROSTATIC: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for 2 hours or 50 psi (3.4 bars) above static pressure in excess if 150 psi (10.2 bars) for 2 hours. Differential dry-pipe valve clappers shall be left open during the test to prevent damage. All aboveground piping leakage shall be stopped. PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1Y2 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 1Y2 psi (0.1 bars) in 24 hours. TESTS ALL PIPING HYDROSTATICALLY TESTED AT: 200 PSI BARS FOR 2 HOURS IF NO STATE REASON: WET SYSTEM DRY PIPING PNEUMATICALLY TESTED QS YES 41 NO EQUIPMENT OPERATES PROPERLY ►,1 YES 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? tfl YES NO DRAIN TEST READING OF GAUGE LOCATED NEAR WATER SUPPLY TEST CONNECTION: '15 PSI BARS RESIDUAL PRESSURE WITH VALVE IN TEST CO NN CTION OPEN WIDE: 6 PSI BARS UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING VERIFIED BY COPY OF THE U FORM NO. 858 I YES FLUSHED BY INSTALLER OF UNDERGROUND 0 YES SPRINKLER PIPING NO NO OTHER, EXPLAIN: BLANK TESTING GASKETS NUMBER USED 0 LOCATIONS NUMBER REMOVED WELDING WELDED PIPING ►5 YES NO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST YES NO AWS D10.9, LEVEL AR -3? DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST YES NO AWS D10.9, LEVEL AR -3? DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO ENSURE THAT ALL DISCS ARE RETRIEVED, THAT OPENINGS IN PIPING ARE YES NO SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS (DISCS) DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? ►5 YES NO Paae 2 of 3 1996 Edition HYDRAULIC DATA NAMEPLATE NAMEPLATE PROVIDED NO IF NO, EXPLAIN: ►5 YES REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: 9 '7, a c SIGNATURES NAME OF SPRINKLER CONTRACTOR: ESCAPE FIRE PROTECTION TESTS WITNESSED BY 7 PROPERTY OWNER (SIGNED) TITLE DATE SPRINKLER CONTRACTOR (SIGNED) TITLE DATE ADDITIONAL EXPLANATION AND NOTES: Page 3 of 3 1996 Edition