HomeMy WebLinkAbout3/27/2002 bfp2839northgate BLACKHAWK
AUT3MATiC SPRINKLERS, INC.
FIRE PROTECTION CONTRACTORS · DESIGN, INSTALLATION & MAINTENANCE
TELEPHONE: (800) 232-7721
P.O. BOX 1887 - WATERLOO, IA 50704
FAX: (319) 232-0330
FOR I CUSTOMER NUMBER I FILE NUMBER
SCORING CENTER
MAILING ADDRESS
NCS PEARSON
STREET LOCATION ~___.<~3~:~ ~]~) ~3'"7~~ I METER NUMBER
3939 NORTHGATE - IOWA CITY~ IA
DATE OF TEST TIME [] A.M. SUPPLY PRESSURE AIR GAP (2 X SUPPLY DIAM.) [] PASS
1/23/2002 2:20 [] P.M. 70 LBS. SUPPLY IN. GAP IN. [] FAIL
TYPE OF ASSEMBLY MANUFACTURER MODEL SIZE I SERIAL NUMBER
DOUBLE CHECK FEBCO 850 4"I 9908161329
HEIGHT OFF FLOOR PROTECTION FROM: COMMENTS: [ NEW INSTALLATION
4" (IN/FT.) FREEZING [] YES [] NO FLOODING [] YES [] NOI [-J YES [~ NO
INITIAL TEST Passed Failed FINAL TEST AFTER REPAIR Passed Failed
REDUCED PRESSURE PRINCIPAL ASSEMBLY: [] [] REDUCED PRESSURE PRINCIPAL ASSEMBLY: BI []
1ST CHECK held in 1ST CHECK held in
direction of flow ~ PSID (5 PSID or more) [] [] direction of flow ~ PSID (5 PSID or more) [] []
RELIEF VALVE RELIEF VALVE
opened at PSlD (2 PSID or more) [] [] opened at ~ PSlD (2 PSlD or more) [] []
DIFFERENCE DIFFERENCE
(1st check - relief)~ PSID (3 PSID or more) [] [] (1st check - relief) PSID (3 PSID or more) [] []
2ND CHECK held in 2ND CHECK held in
direction of flow ~ PSID (1 PSID or more) [] [] direction of flow ~ PSID (1 PSID or more) [-~ []
2ND CHECK held backpressure [] [] 2ND CHECK held backpressure [] []
NO, 2 SHUTOFF VALVE leak tight [] [] NO. 2 SHUTOFF VALVE leak tight [] []
RELIEF VALVE exercised to full open position [] []
NOTE: Failure of any of the above items, requires repair.
INITIAL TEST Passed Failed FINAL TEST AFTER REPAIR Passed Failed
DOUBLE CHECK VALVE ASSEMBLY: [] [] DOUBLE CHECK VALVE ASSEMBLY: [] []
1ST CHECK held in 1ST CHECK held in
directionofflow 1.8 PSID (1 PSID or more) [] [] direction of flow __ PSID (1 PSID or more) [] []
2ND CHECK held backpressure [] [] 2ND CHECK held backpressure BI []
2ND ,.,,-,,~CK held in 2ND CHECK held in
directionofflow 1.6 PSID (1 PSID or more) [] [] direction of flow .__ PSID (1 PSID or more) [] []
NO. 2 SHUTOFF VALVE leak tight [] [] NO. 2 SHUTOFF VALVE leak tight [] []
NOTE: Failure of any of the above items, requires repair.
COMMENTS
REPAIR HISTORY
THE ABOVE REPORT IS CERTIFIED TO BE I'RUE, ACCURATE AND COIVlPLETE
TESTED BY (PRINT) (SIGNATURE) REPAIRED BY (PRINT) (SIGNATURE)
THOMPSON
COMPANY FINAL TEST BY (PRINT) (SIGNATURE)
BLACKHAWK AUTOMA TIC SPRINKLERS, INC.
LICENSE NUMBER I OWNER OI~OWNER'S REPRESENTATIVE I DATE
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