Fire Main Pre-Flush and Bag Test ACSA Approval Request Form Fire Main Pre-Flush and Bag Test ACSA Approval Request Date: * Contractor Name: * Contact Name: * Contact Phone: * Contact Email: * Name of Development / Building: * Address of Proposed Test: * Address of Proposed Test: Address of Proposed Test: Address of Proposed Test: City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Building Permit Number: * Fireline Size (required Flow Rate (GPM) for 10 FT/S Velocity): * 2" (100 GPM)2.5" (150 GPM)3" (220 GPM)4" (390 GPM)5" (610 GPM)6" (880 GPM)8" (1,560 GPM)10" (2,440 GPM)12" (3,520 GPM) Proposed Date of Pre-Flush: * Proposed Time of Pre-Flush: * 121234567891011 : 0030 AMPM Proposed Date of Bag Test (required County Inspector scheduling by Contractor): * Proposed Time of Bag Test (requires County Inspector scheduling by Contractor): * 121234567891011 : 0030 AMPM Description of Flow Measurement Technique by Contractor for Confirmation of Required Flow Rate: * Comments: If you are human, leave this field blank. Submit Δ