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CUfJ 11tAC1 Ufs'S M/11 EfZIAL 8� 1 ES I CEFi 1 IFI(;A I E F=U�i �BUVEGFiVUNU F'IF'llvla <br /> PFtOCEDURE <br /> l�pon cornhle�lon d work��P��on and tesb shalt ba made br Iha conir�cto�e r��etaent�dlve And wltnessed by an ovmere reprssen1a11ve.All delecte ehall be ea►eeled and <br /> system lefl in service belore rnnlrnctors personnol finally k,ave Ihe�ob. <br /> A cerliflcate ShaA be f8�ed oul anA signed by bolh rePrnsenlbive�.Coplea shnA be prepared la:�pprovinp aulhorltbs owr»re,and tontractor.N b understood Ihe owner�rep- <br /> resenldtiv9'S si9nature In no wTy pre�udices any claim�qainst conhaclor lor fautly maAerlal,poor wakrtwnship,or lai�uro Io corrpy w�h app�oving avlhally'e�equtremems oi <br /> Iocat ord'inana�l. <br /> PhOPEFi1Y NAME L DAiE <br /> �►���7 .,L� ���� \/ J�- <br /> PROPERTYADDRESS '�Q OQ�N� T� �jS�P�Z <br /> _��k���£ -- <br /> ACCEPTED 8Y APPROVING AUTNORITIES�NAMES) <br /> � G �t�+ e F v e.n�o <br /> n�onEss <br /> PLANS <br /> INSTALIATION CONFORMS 10 ACCEPiEO PLIINS D VES O NO <br /> EOUIPMENI USE�IS APPROVEO O YES O NO <br /> IF NO.EXPLAIN DEVIATIONS <br /> NAS PEHSON IN C1IARGE OF FII1F FOUICMENT BEEN INSTRUCIED AS iOIOCATION VES O NO <br /> OF CnNiROI VALVES AND C�RE AND MAINTENANCF OF TNIS NEW EOUIPMENf� <br /> IF NO.EXPUIIN <br /> INSTRUCTIONS <br /> NAVE COPIES OF iHE FOLLOW�NG BEEN lEF T ON TNE PREMISES: O VES O Np <br /> 1. SYSiFMCOMPONENISINSTRUCTIONS OYES ONO <br /> 2. CAREANDMAINfENANCFINSTRUC110NS O�ES ONO <br /> 3. NFPA 19A D VE3 O NO <br /> LOCAiION SUPPLIES 9UIl�INGS <br /> OF SYSTEM <br /> YEAR OF ORIFICE TEMPERATURE <br /> MAKE MODEI MANUfAC1URE SRE QUAN111Y RA11Nt3 <br /> GF..NTE�¢.�►` �'�'4----. 1�1'�O Z. ' �1 1 LS <br /> •� SSI� � �g0 � + Z°� l� <br /> SPRINKlEp3 <br /> VI�a.►�aLes�_ — _—_�__ Pr�►�1�t1Nb� —' <br /> , <br /> t <br /> PIPE AND TYpe ol Pipe �Xa�► 1O � A�.1 t� ��... \ <br /> F11T1NGS jype ol Fftlings [��S 'Z{Zp�1 <br /> MAXIMUM TIME TOOPERATE <br /> AUIpM AIARM DEVICE 1HROUGH TES1 CONNEC110N <br /> VALVE IYPE MAKE MODEI MIN. SEC. <br /> ORfLOW <br /> INDICA10q V�N�. N�t�if�ft• W �' � 4��G� <br /> ���1 r1 b� o.O.D. <br /> �Rr va�vE <br /> MAKE MODEL SERIAL NO. MN(E MODEL SERIAL NO. <br /> iIME lp TRIP ?IME WA1EA ALARM <br /> TH1�UiESt WATFR A�FI iA1PPOINT REACNED OPERA1Ep <br /> DRr PIPE CONNECitON' PRESSUf�E PIIESSURE AIR PRESSURE 1ESi OUILET' PiiOPERIY <br /> OPERATiNO MIN. SEC. PSI PSI PSI MIN. SEC. YES NO <br /> TE3T <br /> Wilhout <br /> O.O.b. <br /> ��� Wfth <br /> O.O.O. <br /> IF NO,EXPlA1N <br /> I <br /> 'MEASUREO FROM TIME MSPECTOR S TEST CONNEC110N IS OPENEO. <br /> 85A�1b88) PiiINTEO IN U.S.A. (OVEA) <br />