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Home My WebLink AboutVail Plaza Hotel & Club Ann FS_BF's 05.2010 Western States Fire Protect�on Company 7026 South Tucson Way � Centennial, CO 80112 Phone: 303-792-0022 FAX: 303-792-9049 Automatic Sprinkier System - EnglneeAng - Installatlon - Sales - Service -Inspections for IndusUlal, Commercial and Residential PropeAies Nbuquerque, NM -Anaheim, CA-AusOn, TX - Co!orado Springs, CA - Dallas, TX - Demer, W - Ft Wodh, TX- Houston, TX - Kansas City, MO - Las Vegas, NV - Phcenu, AZ - PoNand, Or ftapitl Gty, SD - San Mtonio, T7(-San Diego, CA-SealUe, WA-Simi Valley, CA - Spokane, WA- Sl Louis, Mo REPORT OF INSPECTION Page 1 of 2 WSFPJOBNUMBER: C�Q3$J �ATeINSPecreo: g/� 3/QQ � Q BRANCH INSPECTING GI011WOOCI Spl'lllgS WSFP INSPECTOR: TOYIy WOOCISITOI11IB0 LOCATION INSPECTED: VaII PI8Z8 HOt@I Hc CIUI� REPORTTO: 5'tgV@ L@gC0 sTReernooRess: 16 Vail Plaza Road c�m Vall STATE: (�,p ziPCOOe: 81657 SITECONTACT: $(@V@ � PHONE: 9]O-4�]-$"I 'IO I. GENERAL YES NA NO SECTION 1A (To be answered by the Owner or the Owner's representative) Was owner available? X 1 Has ihere been any changes in the occuparwy Gassification, machlnery oropera�ons since the last inspec6on7 X 2 Has �here been any changes or repairs to fhe fire protec6on systems since the last inspection? X 3 If a fire occurred since ihe last Inspec�on, have all damaged sprinkler system components been replacedl X 4 Has the piping in all dry systems been checked for proper pitch within the pasl Flve years? X Date Pi[ch Last Checked? (ChecWng is rewmmended at least every five years.) 5 Has ihe piping in all systems been checked for obsWctive materials? X Date Last Checked ObsWetions? (Checking Is recommended at least every Flve years.) 6 Have all fire pumps been tested to iheirtull capaciry ihrough the use of hose sUeams orflow meterswi�hin ihe past 12 X monihs? 7 Aregravity, surfaceorpressuretanksprotecledfromfreezfng? X $ Are any of ihe spnnklers 50 years old or older? (TesUng arnllorreplacement is recommended for such sprinWersJ X 9 Are any exUa high temperature solder sprinklers regularly exposed to tempereWres near 300°F? X SECTION 16. (To be answered by lhe inspector) YES NA NO 1 Have ihe sprinkler systems been extended to ail visible areas of Uie building? X 2 Does there appearto be pmper dearance between ihe top of all storage and ihe spnnkler deflectoR X 3 �n building areas protected by a wet system, does It appear to be heated, including its blind aftics and penmeler areas, where X - accessible? 4 Does il appearthat vislble exterior openirgs are protected against lhe enVance of cold aiR X II. CONTROL VALVES � YES NA NO q Are spnnkler system main control valves and other readlly vlsible vaives In ihe appropriate open or closed posi�on? X RANCH INSPECTIN6: Are readily visible conUol valves sealed or supervised in ihe proper posltion? X Easily Accessl6le Signs Valve Open Sealed? Supervision Operatlonal Control Valves No. of TyPe If yes, how? (Sealetl7) Valves (Locked?) YES NO YES NO YES NO VES NO (Supvd.?) YES NO backflow 2 X X X X supvd X wet system X X X X supvd X zones 5 X X X X supvd X � Western States Fire Protect�on Company 7026 South Tucson Way Centennial, CO 80112 � Phone: 303-792-0022 FAX: 303-792-9049 REPORT OF INSPECTION (CONTINUED) rasezora III. WATER SUPPLIES � TeSt Pipe Located Size PSI eefore PSI Flow After City Private Pressure Fire Pump & Tank Main Drain 2" X Hyd�aulic Placa�d Y@S Pressure Fire Pump ffi Ciry IV. TANKS, PUMPS, FIRE DEPT. CONNECTIONS � YeS NA NO � q Do fire pumps, gravity, suAace or pressure ianks appearto be in good extemal conditio�? X B It appears ihat graviry, sudace and pressure tanks are at ihe propar pressure anNorwaler levels? X C It appears thatfire deparVnent connections are in satisfactory co�dition, coupfngs free, caps or plugs in place and check X valves tight7 D Are fire depariment conneciions visible and accessible? X V. WETSYSTEMS YES NA NO q No. of systems Make & Model tamper & flow B Are cold weafhervalves In the appropriate open or Gosed position for ihe wnent season? X I( ciosed, has piping been drained? X Q Has the ownera ownets representative been advised that cold weather valves are not recommended by NFPA? X D Have readily apparent antifreeze systems bee� �ested? X E Dateantifreezesystemsweretested p The antifreeze tests indicate protection to (temperature): Expansion Tank NO SYS t SYS 2 SYS 3 SYS 4 SYS 5 G �id alarm valves, waterfiow alarm indirators arM retards test sa�sfactonlyY VI. DRY SYSTEMS Annaul Inspection . YES NA No A No. otsystems: 3 Make & Model: VII(Illg Datelastinptested 5/11l2009 Padial X Full B Are the air pressure arM pnming water Ievels normai7 ]( C Did Ue air compressor operete satis(aclonly? ]( D Were readity accessibie and visible low points drained during �his inspection? X E Were dry system trip tests pertormed? (If yes, see DPV Trip Test Repod) X F Dodryvalvesappeartobeprotecledfromfreezing? X G Is the Dry Vaive House Heated? )( VII. Pre•Action Systems X A Make: Model Seriai Number X e Type: Sirgle Interlock Double Interlock X C Acluation ElecincfEleciric ElecUicJNuematic X O�her �� X D Ai� Pressure WalerPressure LowAirAlarm X E AirCompressor Onat Offat Condition X F Solenoid Activa6on PaNal Full Trip (Max 3 yrs) Manual Trip X G Does it appearlhat ihe corMition of ihe vaive is free of physical damage, rust and leaks? X H Are all Trim Valve in ihe appropnate position? X J VJhere ali accessible low poin�s drained during �his inspectlon? 4 drafned+nsar X KDid �heAlarmsrepoAtothebuiidingsFireAlarmPanel? RemoteFireAlarmPanel7 X � vVestern States Fire Protection Company 7026 South Tucson Way Centennial, CO 90112 REPORT OF INSPECTION (CONTINUED) Page3of3 VIII. ALARMS YES NA NO q Did ihe water motor(s) and gorg(s) operete dunng tes6ng? X B Did ihe elecMc alarm(s) operate during tesling? X C Did ihe supervisory alarm service test sa�sfactodly? X IX. SPRINKLERS•�PIPING � YES NA ' NO A Do spnnklers generally appear to be In good external condition? X e Do spnnklers generally appear to be free of corrosion oNoading and vlslble obsWCtions? X C Are exVa spnnklers available on the premises7 X D Dces ihe exterior wndlUOn of the tire spdnkler system appear to be satisfactoryT X E Dces hand hose on the sp�inkler system appear to be in sa�sfac�ory condition7 X X. EXPLANATION OF "NO" ANSWERS (FOR SECTIONS IB thru VIII): Note: Air maintenance device at dry system in garage is not working Note: Could not gain access to all rooms 110, 119, 907, 307, 327, 411, 308, 318, 218 all were occupied Xi. THE INSPECTOR SUGGESTS THE POLLOWING NECESSARY IMPROVEMENTS. (However, these suggestions are not the result of an engineering surve Owner should monitor aux. drains and air compressor cycles dry system may have small air loss LL outside elevator it appears 2 heads may be too close Owner should investigate Owner should investigate repiacing air matntenance device on dry system in parking garage Parking garage right after elevator extt 2 heads appear too dose owner should investigate Escutcheon missing across from Bochco's Bar ,unit 507,hali outside of 216&215, restaurant kitchen area and house keeping room XII. IIST CHANGES IN THE OCCUPANCY HAZARD OR FIRE PROTECTION EQUIPMENT, AS ADVISED BY THE OWNER W SECTION I-A: � XIII. INSPECTION AND SUGGESTED IMPROVEMENTS WERE DISCUSSED WITH THE UNDERSIGNED OWNER OR OWNER'S REPRESENTATIVE: Signature of Owner or Ownets Represeniative Date _5-17-2010 Pnnted Name: Western States Fire Protection Company 7026 South Tucson Way Centennial, CO 80112 Phone: 303-792-0022 FAX: 303-792-9049 FLOW AND TAMPER SETTING RECORD WSFP JQB NUMBER: CI0389 � DATE INSPECTED: May 13, 2010 LOCATION INSPECTED: Vall PI8Z8 HOtCI & CIUb SY3TEfd NUMBER'` z �' - LOCATIO�jj - _. A�+R{�SL�jJNO ' TAMPER REPORFED ' . Parking Control valve outside elavator parking level L01 M005 es Pk water flow alarm outside elavator parking levei L01 M004 alarm 37 sec elevator it valve outside elavator parking level L01 M008 es LL control valve LL outside elevator L02M011 es LL water flow LL outside elevator L02M010 alarm 23 sec atrium- bld - B LL outside elevator above ceilin L02M014 alarm33 sec elevator #1 b&c valve LL outside elevator above ceiiin L02M015 yes L confrol valve L outside elevator L03M003 es L water flow alarm L outside elevator L03M002 alarm 49 sec L- rand stair L outside elevator L02M029 alarm 47 sec UL-control valve U� outside elevator L04M019 es UL water flow alarm UL outside elevator L04M018 alarm 51 sec UL galleria WF alarm UL outside elevator L04M009 alarm 31sec L1 - controi valve L1 outside elevator L05M007 es L1 water flow alarm L1 outside elevator L05M006 alarm 50 sec L2 atrium a alarm atrium hall wa above lobb ceilin L06M012 alarm 37 sec L2 control valve L2 outside elevator L06M003 es L2 water flow L2 outside elevator L06M002 atarm 50 sec L3 control valve l3 outside elevator L07M003 es L3 water flow L3 outside elevator L07M002 alarm 39 sec L4 control valve L4 outside elevator L08M003 es L4 water flow L4 outside elevator L08M002 alarm 38 sec L5 control valve L5 outside elevator L09M003 es L5 water flow L5 outside elevator L09M002 alarm 42 sec elevator e ip rm C V above L5 outside elevator L6 L09M009 es elevator eqip rm WF above L5 outside elevator L6 L09M008 alarm 33 sec main control boiler room L02M018 es B.F.P.#1 valve boiler room L02M019 es B.F.P.#2 valve boiler room L02M037 es main water flow boiler room L02M036 alarm 47 sec ! Western States I+'ire Protect�on Corripany 7026 South Tucson Way Centennial, CO 80112 . Phone: 303-792-0022 FAX: 303-792-9049 Automatic Sprinkler System - Engineering - Inslallatlon - Sales - Service -Inspections for Industrial, Commemial and Resldenlial Pwperties AlEUrque, NM -Anaheim, CA -Austin, TX- Coiorado Springs, CO - oallas, iX - Denver, CO - Fl WoM, TX- Houslon. TX - Kansas Gty. t10 - Las Vegas, NV - Phoen&, AZ- PoNand, Or Rapid City, SD- San Mfonio, TX - San Diego, CA- SeaWe, WA- Simi Valiey, CA - Spokane, WA- 5t �ouis, Mo REPORT OF ANNUAL DRY PIPE/DELUGE/PREACTION VALVE INSPECTION Page1 of2 WSFP JOB NUMBER: CI0389 DATE OF INSPECTION: 5/1 312 0 1 0 BR4NCH INSPECTING: GIB�WOOd SPfI1l9S WSFP INSPECTOR Tony & Tom&Bo LOCATION INSPECTED: V81I PI8Z8 HOtBI $i CIUb � REPORTTO: $teVe srReErao�Ress: 16 Vail Plaza Road CITY: V81� STATE: C� ZIPCODE: SITE CONTACT: Steve Legro PHONE: 970-477-8114 DRY PIPE VALVE(S) System # 7 System # 2 System t{ 3 System # 4 i vawe(S) serialNumbers W00291928 W00291928 W00291928 2 Manufactures Name Vlklllg VIkIi1g Vlklfl 3 Manufaciurers Date 5-Dec Dec-05 5-Dec 4 Valve Model F-1 F-1 F-1 5 VaWe Size � Q inch 4 Inch �{ inch inch Area Served? Parking Garage Loading Dock Porte cochere 6 6ctent of Dry System per Valve Number of Heads? approx. approx. approx. approx. Numberof Low Polnt Drafnsl 2 2 3 7 Was Slope Of piping cheGked as part of this Inspec[ionl YES X NO YES )( NO YES X NO YES NO 8 �Date slope last checked? On Install 2008 mo $ yr mo $ yr mo $ yr mo yr 9 Date Last Ope�ated? 5 mo 9 yr 5 mo 9 yr 5 mo J yr mo yr SupplySide (water 148 ibs. 140 ibs. 135 Ibs. Ibs. 10 ReadfngsBeforeTest? SystemSide (air 38 Ibs. 37 Ibs. 38 ibs. Ibs. Quick-opening Device (air N!A ibs. N/A ibs. N(A Ibs. � Ibs. 11 Are gauges in proper working order? )( YES NO X YES NO X YES NO YES NO Siz 1 "(OrfICB �nches 1 "/OffIC2 inches 1 °/OffIC2 inches inches 12 Test Valve Information? ��o top of ramp Was gate valve be�ow dry valve fully opened during test7 No No No 13 TAMPER L02M005 L05M011 L02M067 AlrPressure � $ Ibs. 2� Ibs. Ibs. Ibs. 14 ValVe tfipped at? Water Pressure � 148 Ibs. 140 Ibs. 135 Ibs. Ibs. Time n!a min sec min sec min sec min sec If full trip test was pedormed indicate time it took for 15 wate� to reach Inspectors test oullet? min sec min sec min sec min sec � Western States Fire Protection Company 7026 South Tucson Way Centennial, CO 80112 Phone: 303-792-0022 � FAX: 303-792-9049 Page 2 of 2 Thevalveisfreeofphysical yES j�' NO YES X NO YES X NO YES NO damage� 16 Exterior Valve Condition All trim valves are in ihe appropriate position X YES NO X YES NO )( YES NO YES NO The Intermediate chamber is no YES )( NO YES j�' NO YES �' NO YES NO leaking4 IntenorofVaiv good good good Moving Par� good good good 17 Interior Valve Condition RubberFaci�g gOOd g00d 900d � Seats and Gaskets gOOd gOOd gOOd 18 Did the supervisory Low alr signal work? PSI? 2$ pgj L02M006 31 pSl L05M009 29 psi L02M068 1g Did alarms operatewhen system was tripped? )( vES No X YES No X vES ND YES No 20 Wefe all loW po(nt drains drained? )( YES NO X YES NO X YES NO YES NO Z� Were printed instructi0n on maintenance of low polnt - X YES NO )( YES NO X YES NO YES NO drains given to customer7 22 Were all control valves Ieft in the open position? )( YES NO )( YES NO �' YES NO YES NO 23 Were alarm control vaives Ieft In lhe open position and sealed? X YES NO X YES NO )( YES NO YES NO 24 QUICK OPENING DEVICES SYSTEM NO. 1 SYSTEM NO. 2 SYSTEM NO. 3 SYSTEM NO. 4 25 Devlce Serial Number n!a 1118 Il/8 26 Manufacture 27 Type and Model � 28 Air pressure In upper chamber? 0 Ibs. 0 Ibs. 0 Ibs. 0 Ibs. 29 Qulck opening device tripped ai7 min sec min sec min sec min sec 30 � Quick opening devlce left In service and control open and sealed? � List any Unsatisfactory Conditions: Garage air maintence device does not appear to work owner should investigate 31 Remarks: garage alarm L02M004 loading dock alarm L05M010 porte corchere alarm L02M066 Owner should investigate replacing air maintence device at parking garage dry system 32 0 I e a I �� Western States Fire Protect�on Company 7026 South Tucson Way Centennial, CO 80112 Phone: 303-792-0022 FAX: 303-792-9049 Auloma6cSOM��'fl�� - Erqinee�ing - Inslallation -Sales- ServKe -InSpeCiaiS ttt IiMUSlrial, Commerdal aM Resitlential PropeNes loretlo Spn�s, CO - DaIUe, TX- Denvet, CO- Ft Wath,7X- Nouston, TX- Kansas City, MA- Las Vegas, NV- Phcentx,PZ -PwtlaM, Or-Rap(d City, SD - SanMionb, TX- San Diego, CA- Seal�e,W BACKFLOW ASSEMBLY TEST AND MAINTENANCE REPORT � CUSTOMER MUST RETAIN A COPY OF THIS REPORT FOR A MINIMUM OF THREE YEARS WATERDIST/AUTNORITY: V81I METERACCOUNTNO: � TESTNO: CI00B9 seaweEwvne: Vail Plaza Hotel & Club seav�eenooRess: 16 Vail Plaza Road Vail , CO. WNTACTPERSON: StOVC L@QrO 71TLE: Enq• aHOne: 970-477•8114 O W N E RM,GMrC0/COMRACTOR MAILMGAODRESS: � CONTACT PERSON: TITLE: PHONE: NEW: E%�S77NG. X REPLACEMENTPOR: USE: CONTAINMENT: J( ISOtAT10N: DOMESTIC: �( FIRE: IftRIGATION: PROCESS: . A5SEMBLYTYPE: REOUCEDPRESSURE: �( OOUBLECHECK PRESSUREVACUIIMBREAKER: MF6: NIa{t$ MO�ELNO: QO9 SIZE: s^ SERWLNO: ��258104�� DATEINSTALLED: n�a LASTINSPECTION: LINEPftESSURE: $Q PSI. LOCATION: I�ISB� lOOfll IOW@f LOVBI INRL1l RESULTS COMMENTS RE-TEST RESULTS TIGHTNESS OIFFERENTUaL TIGHTNESS DIFFERENTV+L Check No. t (PVB, RP, DC) TIGHT �.O cnecic No. z �ac, oc� TIGHT 1 .8 Rellef Velve (RP) o en 2_8 Buffer (RP) Q_2 � Alr Inlel (PlB) Shut-oH VaNe No. t Shu4off VaNe No. 2 Tiaht REPAIR/COMMENTS ASSEMBLYMECHANICALTEST; X PASS Failed If inechanical test tails, the water purveyorlauthority must be notlfied Immediately and repairs made as soon as possible. � � ALARM COMPANY NOTIFICATION: NIA TURN-OFF DATE: $I'I �/ZO'IO TIME: $:OO TURN-ON DATE: SI'I7/ZO'I O TiME: 4:30 PM . TECHNICIAN CERTIFIES THI5 ASSEMBLY HAS BEEN 7ESTED IN ACCORDANCE WITH A.S.S.E. PROCE�URE 6010• 1015 CERTIFICATION resreRSrunae: AnthonvWoods No 13158 �cPiRES: 3131/2013 TESTERSPHONE: $�$-�JZ-�022 TESTERS SIGNATURE: D8(0 Of TBSt S-'I7-'I O TESTGAUGE: MIQWBStB45511#OSOH24'IG GAUGERECERTDATE: 9($IYO'IO OWNER ORAGENT SIGNATURE �� Signalure fndicates vedflcation by sigoer that the Isolation valves are in the open posltlon aRer tha test is completetl. �� Western States �'ire Pr°otection Co pany 7026 South Tucson Way Centenniai, CO 80112 Phone: 303-792-0022 FAX: 303-792-9049 Autanatic SpinkkrSysfem - Engineering - Instailation -Sales-Servke-Inspections fa Induslriai, Comme�tiai antl ResWential PropeNes :oretlo Spiigs, GO - Datlas, TX- �enver, CO- Ft WoM, 7X- Housfon, TX- Kansas City, MO- Las Ve9as, NV- Phcenua, AZ- PoNanQ Or- Rap!d Ciy, SD - SanAnlonio, TX-San �iego, CA- SeaHle, W BACKFLOW ASSEM�LY TEST AiVD MAINTENANCE REPORT CUSTOMER MUST RETAIN A COPY OF THIS REPORT FOR A MINIMUM OF THREE YEARS WATERDIST/AUTHORIiY: VdII METERACCOUNTNO: . TESiNO: C10389 seawce uune: Vail Plaza Hotel & Club seawceaoortess: 16 Vail Plaza Road Vail . CO. CONiACTPERSON: SLBV@ L@IIrO TRLE: Ena• PHONE: .q7O-477-H� � 4 OWNER/MGMTCOMAMRACTOR: � MAILINGAO�RESS: CONTACTPERSON: TIRE: PHONE: NEW: EXISTING: �( REPIACEMENTFOR: USE: CONTAINPAENT: �( ISOV+TION: OOMESTIC: FIRE: X IRRIGATION: PROCESS: ASSEMBLYTPE: RE�UCEDPRESSURE: �( �OUBLECHECK PRESSUREVACUUMeREAKER MfO: WIII(II15 n+ooE� NO: 375A SRE: 6�� SERIALNO: ��X04918�� . DATEINSTALLEO: � n�a fASTINSPECTION: LINEPRESSURE: �l30 PSI. LOCA710N: RISB� (O011l IOW2t' L@VBI MRIAL ftESULTS COMMENTS RE-TEST RESULTS TIGHTNESS DIfFERENTV�L 71GHTNESS DIFFERENML Check No. 1 (PVB, RP, DC) TIGHT 8.2 CheGc No. 2 (RC, DC) TIGHT 3.4 RellefVaNeiRP) o en �_8 BuRer (RP) 5.Q � Alr Inlet (PV8) ShuFOff VaNe No. 1 Shuboff Vahra No. 2 1'Iq ht REPAIWCOMMENTS Note: prior to inspection and main drain test air relief valve was visibty failing note after flushing device passed test on 5-17 ASSEMBLYMECHANICALTEST: X � PASS Failed � If inechanical testfalis, the water purveyorlauthority mus[ be notiFled immedfately and repalrs matle as soon as possible. ALARMCOMPANYNOTIfICATION: N/A TURN-OFFDATE: 5I'I7IZO'IO TIME: $:OO TURN-ONDATE: SI'I�/IO'IO riMe: 4:30PM TECHNICIAN CERTIFIES THIS ASSEMBLY HAS BEEN TESTED IN ACCORDANCE WITH A.S.S.E, PROCEDURE 5070- 1013 � CERTIPICATION TESTERSNAME: Al1fIlOI1V WOOfIS No, 13158 exPiaes: 3/31@013 TESTERSPHONE: $O$-�JZ-O022 resreRS sicw.TUae: Date of Test 5-17-10 TESTGAUGE: MIfIWQStS4SS11#OHOB24'IB GAUGERE-CERTDATE: JIHIZO'IO OWNER OR AGENT SIGNATURE: _ Signawre indicates vedOcaHOn by signerthat the Isoiatlon valves are In the open poslHOn after the test Is completed. i �t� Western Sta�es �i�e Protec�ion Cornpany 7026 South Tucson Way Centennial, CO 80112 Phone: 303-792-0022 FAX: 303-792-9049 Automatk Spnnkix Svst¢m- E�gineering- Insleliation - Saks- Servi�n-Inspedions Iw IMusirial, Commertlai and ftesidentlal PropeNas � bredoSpnngs, CO - Dailas, T%-0enver, CO - FIWMh, TX- HOUSfon, T%- KanusC'ity, MO-lasVegas, NV- PhoeNx, AZ- PONa�M, Or- Rap'.dCity, 50 - SanMtonb, TX-SanDiego, CA-SeattJe. W BACKFLOW ASSEMBLY TEST AND MAINTENAMCE REPOR'T CUSTOMER MUST RETAIN A COPY OF THIS REPORT FOR A MINIMUM OF THREE YEARS WATER OIST/AUiHORIN: Vail METER ACCOUNT NO: TEST N0: CI W 89 SEftVICENAME: �/al� P�BZa HOtO� $t (�i�Ub � seawceaooaess: 16 Vail Plaza Road Vail . CO. CONTACTPERSON: St@V@ LQQI'O T�T�E: Ena, PHONE: J7O-477•S'I 'I4 0 W NERlMGMTCO/CONTRACTOR MAILING A��RESS: CONTACTPERSON: TIRE: PNONE: NEW: E%ISTING: J( REPLACEIAENTFOR: USE: CONTNNMENT: X ISOLATION: UOMESTIC: FlRE: IRRIGATION: �( PROCESS: ASSEMBLYTYPE: REOUCEDPRESSURE: �( OOUBLECHECk PRESSUREVACUUMBREAKER MFG WattS MODELNO: 9O9M�IQT SIZE: '1^ SER1AlN0: ��424939�� DATEINSTALLED: n�a LASTINSPEC710N. IINEPRESSURE: 85 P51. �ocanoN: Riser room lower Level INRIAL RESULTS ftE-TEST RESULTS � CO/MIENTS TIGHTNESS DIPFERENTWL TIGHTNESS DIFiERENTUQ Check No. t (PVB, RP, DC) TIGHT 9_Y ' Check No. 2 (RC, OC) TIGHT 7 .4 Relief VaNe (RP) o en � 3_2 euffer (RP) 6 � Alr inlet (PVB) Shul-off VaNe No. 1 Shut-off Vaive No. 2 "�iaht REPAIR/COMMENTS ASSEMBLYMECHANICALTEST: X PASS Failed If inechanical testfails, tha water purveyorlauthority must ba notiFletl immediately and repalrs matle as soon as possible. ALARM COMPANY NOTIFICATION: N/A TURN-OFFDATE: SI'I �IEO'IO TIME: $:OO TURN-0NDA7E: SM �I/YO'IO nMe: 4;30 PM � TECHNICIAN CERTIFIES THIS ASSEMBLY HAS BEEN TESTED IN ACCORDANCE WITH A.S.S.E. PROCEDURE 5070- 1013 CERTIPICATION TESTERSNAME: Al1YNOIIV WOOCIS No. 13158 �cPiRes: 3/31@013 TESTERSPHONE: $Q$-]JZ-QQ22 resreas sicrwTURe: Date of Test 5-17-10 resr cnuce: Midwest 845 sn#08082416 GAUGE RE-CERT DATE: J/E/ZO'I O OWNER OR AGENT SIGNATURE: Signature Indicatas vedOcation by signer that the Isolation valves are In the open position akerthe test is completed.