Flow Test Information Sheet Note: ERFPD recommends a two-hydrant test

1. Reason For Test: Design Base Other 2. Address of Property: ________________________________________________________________ 3. Date & Time of Test: Date: _____________ Time: _____________ (am) (pm) 4. Test Conducted by: _________________________________________________________________

Name Title Affiliation 5. Test Witnessed by: __________________________________________________________________

Name Title Affiliation 6. Source of Water Supply: Gravity Pump Other: _______________________________ 7. Name of Water District: _____________________ Fire District: __________________________ 8. Is water supply provided with PRV STAs Yes No

(If so, what is PRV outlet setting? ______________PSIG) Make/Model of Hydrants: __________________________ 9. Area Map: (Draw Sketch showing property location; bounding streets and names, North Arrow, location of fire main tap to subject building, hydrant locations and identification numbers, distances from hydrants to property, elevations of hydrants and property floors or grade, all water mains, sizes and interconnection valves etc.)

N

10. Flow Test Data - Date Gages Last Calibrated: ____________________ Flow at Hydr. Number

Static at Hydr. Number

Static PSIG

Residual PSIG

Flow GPM

Outlet Coefficient

Adjusted GPM

Pitot PSI

11. Signed: _____________________

12. Witness: ____________________ At completion of test hydrants were verified to be in the off position and observed to drain down. Initials: ________