Version 3, 14 December 2018, Page
15
of
16
Galvin Engineering Thermostatic Mixing Valve or Tempering
Valve Commissioning Report
Valve Location/Building : ____________________________________________________
Room or Area: ____________________________________________________________
Work Order No.:___________________________________________________________
Warm
Water
Outlet
Fixture
No.
*Name/Type/Size and location
of Outlet Fixture (Bath, Shower,
Basin, Other)
Flow rate of Design Water (LPS) Temp of Warm Water (C)
One Outlet
in Use
**All
Req‘d
Outlets in Use
One Outlet
in Use
**All Req’d
Outlets in
Use
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
*Give details of brand and model designation.
** Commensurate with the design flow rate for the mixing valve.
Note: An accurate digital thermometer is necessary for the temperature measurements
Prescribed temperature range for warm water ______________ C to _________________C
Thermal shutdown at both minimum and maximum design flow rates
(Passed/Failed) Yes
□
No
□
Name of Plumber: _____________________________________
License/Cert No. _________________________________
ensee’s gnature: __________________________ Date: ______________ Telephone Number: ______________________
