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Sprinkler Inspection Report 7/15/2010

Inspection, Testing, and Maintenance Cover Sheet NFPA 25 as amended by CCR, Title 19

Property Information: Name: Address: City: Zip: Contact: Telephone: Sample Site Sample Address Fresno 93701 Contact, Sample (559)123-4567 Occupancy/Use: Construction Type: No. Stories: Year Constructed: B - Business II-B - NonComb - UnProt 1 Unknown

Sample Site Page 1 of 5

Contractor Information: Name: Address: City: State: Telephone: CA License# Job # Performed by: D Escola Signature Life-Safety Services, Inc. 2491 Alluvial Ave #59 Clovis California (559)392-2838 933910 (C-10 & C-16)

1

Number of System Risers

Copy sent to: Owner Fire AHJ Contractor Date Date Date

NOTES: 1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2002 Edition as amended by California Code of Regulations, Title 19, S901 to S906. 2) Inspection Items may be performed by the Owner in accordance with California Code of Regulations Title 19 S804.1(a) NFPA 25 Chapter

Note: Contractor information may be pre-printed

Forms included with this report

Number of Forms

N/A

FAIL*

PASS

Automatic Sprinkler System Standpipe and Hose Systems Private Water Supply System Fire Pump Water Storage Tank Water Spray System Foam Water Sprinkler System

5 6 7 8 9 10 11

1 0 0 0 0 0 0

0 0 0 0 0 0 0

1 0 0 0 0 0 0

0 0 0 0 0 0 0

*See "Deficiencies and Comments" section at end of each respective form.

State Fire Marshal AES 1

March 21, 2006

Sprinkler Inspection Report 7/15/2010

Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25 as amended by CCR, Title 19

Date of Inspection, Testing, Maintenance: Property Information: Name: Address: Sample Site Sample Address Type of System: Wet Pipe Dry Pipe Preaction Deluge 7/15/2010 System Riser ID: Sample Riser

Sample Site Page 2 of 5

Page 1 of 4

City:

Fresno

Main Drain Test Results: Initial Static Pressure: Residual Pressure: Restored Static Pressure: 72 54 73 (psi) (psi) (psi

Abbreviation Key: I = Inspection T = Test M = Maintenance A-O = After Operation MI = Per Manufacturer's Instructions

Item

1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17

Activity

I I I I I I I I I I I I I I I I I

Frequency

Daily Weekly Daily Weekly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Quarterly Annually

Description

Preaction/Deluge Valves - Enclosure temperature Dry Pipe Valves - Enclosure temperature Gauges (Dry, Preaction, Deluge Systems) Control Valves Alarm Devices Gauges (Wet Pipe Systems) Hydraulic Nameplate Pipes and Fittings Sprinklers Spare Sprinklers Fire Department Connections Alarm Valves - Exterior Inspection Preaction/Deluge Valves - Exterior Inspection Pressure Reducing Valves Dry Pipe Valves - Exterior Inspection Backflow Preventers Buildings

NFPA 25 Reference

12.4.3.1 12.4.4.1.1 5.2.4.2 5.2.4.3 12.3.2.1 5.2.6 5.2.4.1 5.2.7 5.2.2 5.2.1 5.2.1.3 12.7.1 12.4.1.1 12.4.3.1.6 12.5.1.1 12.4.4.1.4 12.6.1 5.2.5

Fail

N/A

N/A N/A N/A

Pass

Pass Pass Pass Pass Pass Fail Pass Pass N/A N/A N/A N/A N/A Pass

State Fire Marshal AES 2

March 21, 2006

Sprinkler Inspection Report 7/15/2010

Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25 as amended by CCR, Title 19

Date of Inspection, Testing, Maintenance: Property Information: Name: Address: Sample Site Sample Address Type of System: Wet Pipe Dry Pipe Preaction Deluge 7/15/2010 System Riser ID: Sample Riser

Sample Site Page 3 of 5

Page 2 of 4

City:

Fresno

Item

1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 1.26 1.27 1.28 1.29 1.30 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9

Activity

I I I I I I I I I I I I I T T T T T T T T T

Frequency

Annually Annually 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years 5 Years Annually Annually Annually Annually Annually Annually Annually Annually Annually

Description

Hangers Seismic Braces Hangers (Accessible concealed spaces) Seismic Braces (Accessible concealed spaces) Pipes and Fittings (Accessible concealed spaces) Sprinklers (Accessible concealed spaces) Alarm Valves - Interior Inspection Alarm Valves - Strainers, filters, orifices Check Valves - Interior Inspection Preaction/Deluge Valves - Interior Inspection Preaction/Deluge Valves - Strainers filters, orifices Dry Pipe Valves - Interior Inspection Dry Pipe Valves - Strainers, filters, orifices Alarm Devices (90 Sec) Main Drain Test (Enter data on Page 1) Antifreeze Test Control Valve - Position Control Valve - Operation Supervisory Preaction Valve - Priming Water Preaction Valve - Low Air Pressure Alarm Preaction Valve - Full Flow Trip Test

NFPA 25 Reference

5.2.3 5.2.3 5.2.3.3 5.2.3.3 5.2.2.3 5.2.1.1.4 12.4.1.2 12.4.1.2 12.4.2.1 12.4.3.1.7 12.4.3.1.8 12.4.4.1.5 12.4.4.1.6 5.3.3 12.2.7 12.2.6 12.2.6.1 12.3.3.4 5.3.4 12.3.3.1 12.3.3.1 12.3.3.5 12.4.3.2.1 12.4.3.2.10 12.4.3.2.2

Fail

N/A

Pass

Pass Pass

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Pass Pass N/A Pass Pass Pass N/A N/A N/A March 21, 2006

State Fire Marshal AES 2

Sprinkler Inspection Report 7/15/2010

Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25 as amended by CCR, Title 19

Date of Inspection, Testing, Maintenance: Property Information: Name: Address: Sample Site Sample Address Type of System: Wet Pipe Dry Pipe Preaction Deluge 7/15/2010 System Riser ID: Sample Riser

Sample Site Page 4 of 5

Page 3 of 4

City:

Fresno

Item

2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 3.1 3.2 3.3 3.4 3.5

Activity

T T T T T T T T T T T T T T T T M M M M M

Frequency

Annually Annually Annually Annually Annually 3 Years 5 Years 5 Years 5 Years 5 Years 5 Years 10 Years 20 Years 50 Years 75 Years

Description

Dry Pipe Valve - Priming Water Dry Pipe Valve - Low Air Pressure Alarm Dry Pipe Valve - Quick Opening Device Dry Pipe Valve - Trip Test Backflow Preventer Assemblies Dry Pipe Valve - Full Flow Trip Test Gauges Pressure Reducing Valve Fire Department Connection Backflush Sprinklers - Extra High Temperature Sprinklers - Corrosive environment or corrosive water Sprinklers - Dry Sprinklers - Fast Response Sprinklers Sprinklers 75 years in service Sprinklers manufactured prior to 1920 - Replace

NFPA 25 Reference

12.4.4.2.1 12.4.4.2.6 12.4.4.2.4 12.4.4.2.2 12.6.2 12.4.4.2.2.2 5.3.2 12.5.1.2 12.7.4 5.3.1.1.1.3 5.3.1.1.2 5.3.1.1.1.5 5.3.1.1.1.2 5.3.1.1.1 5.3.1.1.1.4 5.3.1.1.1.1 12.3.4 12.4.3.3.2 12.4.4.3.2 12.4.4.3.3 Chapter 13

Fail

N/A

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Pass

Annually Annually Annually Annually 5 Years

Control Valves Preaction/Deluge Valves Dry Pipe Valves/Quick-Opening Devices Dry Pipe Valves - Low Point Drain Obstruction Investigation

Pass N/A N/A N/A N/A

State Fire Marshal AES 2

March 21, 2006

Sprinkler Inspection Report 7/15/2010

Inspection, Testing, and Maintenance Fire Sprinkler System NFPA 25 as amended by CCR, Title 19

Date of Inspection, Testing, Maintenance: Property Information: Name: Address: Sample Site Sample Address Type of System: Wet Pipe Dry Pipe Preaction Deluge 7/15/2010 System Riser ID: Sample Riser

Sample Site Page 5 of 5

Page 4 of 4

City:

Fresno

Deficiencies and Comments: Item Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above:

1.9 2.1 3.1 Exterior sprinkler heads have cobwebs and dust - need to be cleaned Alarm to Building Fire Alarm in 63 seconds All control valves fully closed and fully reopened - OS&Y valves stems lubricated

See Continuation Page(s) PASS FAIL

(Indicate the number of continuation pages)

Signature

Date

State Fire Marshal AES 2

March 21, 2006

Information

5 pages

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