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OPERATION <br /> O PNEUMATIC 0 ELECTRIC O HYDRAULIC <br /> PIPING SUPERVISED OYES ONO DETECTING MEDIA SUPERVISED 0 YES 0 NO <br /> DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATIONS O YES ONO <br /> DELUGE& I AN ACC SIL CIL/ IN AC CIRCUI 0• S ING I NO, XPLAIN <br /> PPEACTION <br /> VALVES 0 YES O NO <br /> DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO <br /> MAKE MODEL SUPERVISION LOSS ALARM OPERATE VALVE RELEASE OPERATE RELEASE <br /> YES NO YES 1 NO - MIN. SEC. <br /> HYDROSTATIC_Hydrostatic tests shall be made at not teas than 200 pal(17.8 bars)for two hours or 50 pel(3.4 bars)above static pressure In excess <br /> at 150 psi(10.2 bars)for two hours,Differential dry-pipe valve dacpers shall be lett open during teat to prevent damage.All aboveground piping leakage <br /> TEST shall be stopped. <br /> DESCRIPTION <br /> PNFLJMATIC:Establish 40 psi(2.7 bars)air pressure and measure drop which shad not exceed 1.1/2 psI(0.1 bars)in 24 hours.Test pressure <br /> tans at normal water level and air pressure and measure air pressure arm wrier)shad not exceed 1-1/2 pal(0.1 bars)In 24 hours. <br /> ALL PIPING HYDROSTATICALLY TESTED AT'Z.UO PSI FOR Z,,HRS. IF NO,STATE REASON <br /> DRY PIPING PNEUMATICALLY TESTED O YES O NO <br /> ECUIPMENT OPERATES PROPERLY O YES O NO <br /> CO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS.SODIUM SILICATE OR <br /> DERIVATIVES OF SODIUM SILICATE,BRINE,OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR <br /> TESTS STOPPING LEAKS? RYES 0 NO <br /> DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST <br /> TEST SUPPLY TEST CONNECTION: PSI CONNECTION OPEN WIDE PSI <br /> UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MACE TO SPRINKLER PIPING, <br /> VERIFIED BY COPY OF THE U FORM NO.858 ❑ YES O NO OTHER EXPLAIN <br /> FLUSHED BY INSTALLER OF UNDER- <br /> GROUND SPRINKLER PIPING ES 0 NO <br /> BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED <br /> GASKETS NONE <br /> WELDED PIPING YES O NO <br /> IF YES... <br /> DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY <br /> WITH THE RECUIREMENTS OF AT LEAST AWS D'^9.LFVFI..AR-3 YES O NO <br /> WELDING CO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS CUALIFIED IN <br /> COMPLIANCE WITH THE RECUIREMENTS OF AT LEAST AWS D10.17,LEVEL AR-3 YES O NO <br /> CO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A <br /> DOCUMENTED DUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE <br /> RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH.THAT SLAG AND OTHER <br /> WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNAL DIAMETERS OF <br /> PIPING ARE NOT PENETRATED IES 0 NO <br /> CUTOUTS CO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL <br /> (DISCS) CUTOUTS(DISCS)ARE RETRIEVED? .ES 0 NO <br /> HYDRAUUC NAME PLATE PROVIDED IF NO,EXPLAIN <br /> DATA <br /> NAMEPLATE YES O NO <br /> DATE LEFT IN SER V/ICEIWITH ALL CONTROL VALVES OPEN: <br /> REMARKS <br /> NAME OF SPRINKLER CONTRACTOR <br /> OLSEN FIRE PRGrFrrTC N TNC_ <br /> TESTS WITNESSED BY <br /> SIGNATURES FOR PROP,ERTY OWNER(SIGNED) ITITLE m�v S / 1 <br /> CATE /0/`o� <br /> FOR PRI KL R CON OR( NE TITLE i DATE ! <br /> ADDITIONAL EXPLANATION AND NOTES <br /> —41 6LQ.1X1, 1 a/ 1014-e id Sall) <br /> ass asrx <br />