Contractor'S Material And Test Certificate Page 2
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1
2All new underground piping hydrostatically tested at
Joints covered
HYDROSTATIC
Yes
No
psi
for
hours
TEST
Total amount of leakage measured
gallons
hours
LEAKAGE
TEST
Allowable leakage
gallons
hours
Number installed
Type and make
All operate satisfactorily
HYDRANTS
Yes
No
Water control valves left wide open
Yes
No
If no, state reason
CONTROL
VALVES
Hose threads of fire department connections and hydrants interchangeable with those of
the fire department answering alarm
Yes
No
Date left in service
________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
REMARKS
________________________________________________________________________________________________________________________
Name of installing contractor
SCR-
C of R No.
Contractor’s Address
City
State
Zip
Signature
Tests witnessed by
For property owner (signed)
Title
Date
For Installing contractor (signed)
Title
Date
Additional explanation and notes
I certify that the information herein is true and that this portion of the sprinkler system was installed in
accordance with Chapter 6003, Texas Insurance Code and the rules and standards adopted by the State Fire
Marshal’s Office.
RME
Responsible Managing Employee (signature)
Responsible Managing Employee (print or type name)
CERTIFICATIO
RME License Number
Date
Original COPY 1 Posted at site or give to owner
COPY 2 for the installing firm in file accessible to SFMO
DISTRIBUTION:
COPY 3 for local approving authority within 10 days after completion
U
SF042 Rev. 07/09
Page 2 of 2
Contractor’s Material and Test Certificate for
nderground Piping
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