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I <br /> PIPE TEST CERTIFSCATE <br /> � PROJECT .4t.l.v.A. r/P B/ellr <br /> PROJECT NO. � <br /> BUILDINC N0. � �YD - P.2 , <br /> . ' <br /> In�tructlono: This�form muct be tilled out for all eomplaeed pipe�teetinq. <br /> Fill in only those sectLons vhLch apply to the tect betng done. Where <br /> eppropri�te, th� Boeinq Repra�entativa must siqn tha torm before vork eterts and <br /> „ in all cases muat elqn ae vitneasing che test. Upon completion, coples shall be <br /> ., dl�trlbu:�d per tb• lisc beloN. <br /> • Vt�ual Inapectlon Completed <br /> �r � BxLg Aepresencative <br /> , ' Safety Review Completed__ wvx`�- � �'J'�,i <br /> 'S hustin Aepreaenutfve <br /> Fluahing of Plpe compleced IV/A <br /> � <br /> , .. Austin Pe?nsestacive <br /> Disintectlon of water system compleeed �J�A <br /> Hustin Pap:eses:etive <br /> Line Intormation � <br /> Draviny No.s RFM 4 <br /> Laution�N iPceo /2y'A0o✓FE'ao�Leuilding <br /> Portion ?ested ( ✓S hll or O Partial�1Ai�/ L iN6 r Baoa�,v t i.v.v� �'O • � <br /> � B�/TTE,C p�tL ✓At��CJ <br /> 'Test Info=mation <br /> Date�tc•.r�fnl.P 1� 2 �/�/ Time_/•'O/1 /�/Yl /POu <br /> Test Hydros:atfc ( ) F.ir y�) Haloearbon ( ) other ( � <br /> Test Media (be spaoi:ic) � <br /> Speeificaiion Pr�ssure (j � PSIG T86L P:escure � (7 ?SIG <br /> � <br /> o:her Raquirem�nte . <br /> ?��t A�tult• � <br /> S:artinq Pr�s�u.�_��• S�+ 9v (u .`Z• PSIG <br /> Endinq Pre�sure lvG� • _T 4- !., 2. PSIG <br /> Tes: Dura:ion__ 3n Ni�u„r(.� <br /> � ;� � .xemarY.e:_P/ PE Afei�/ ,OND RP,An�rH L/N£S tl�D �Z. /bJ f� S. /. <br /> � , Foo 4,�NoUPS wiTH �vo PKe55[i.Pt� Opo/� �d�� T.vPr.cn < <br /> � .tNn wr-�.� � H.!/1 So,o,o vr s �r c., rr� <br /> I <br /> ( CERTIFICATION: <br /> I cartify ehai the � ove nformetion co rer.; end that the pipe?ina <br /> . ' deccribed abov va• p:epare and ces: in my resence in accordenca wi:h <br /> the speci:icacion , ndicaced bove. <br /> si� a ny % - 2-9y <br /> . on:rac;o_�j� p:esen :iva Da:e <br /> fOND.�,�s0�� - m.oh ,�� E2 <br /> conc:ac:or <br /> Tes: Hltnessed by K�J�- �T'�l�� <br /> -� hus:in Aepre n:a:iva Date <br /> � <br /> �z zy� <br /> 3oeih resen:e:ive '�lr.te <br /> Y.Cs Auakin Projee; Supesintenden: 8oe'_ng Represen:ative <br /> �uatin Qaali..y Assurance Enqinoer Hoeinq que?.t}' Control <br /> R013 E/10/?1 REV • • <br />