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90VII., 7- OP_L`
25 -78 INSPECTION, TESTING, AND MAINTENANCE, OF WATER -BASED FIRE PROTECTION SYSTEMS
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inspection, Testing, and Maintenance Cover Sheet
NFPA 25 as amended by CCR, Title 19
Property Information:
Name: . yBi/ a k M1.1 ]-A4tWOccupancy /Use: Meal. c1. _I or- CA4j'
Address: Construction Type:
City: a— _';( c( No. Stories:
ZIP: 4 3 3 3 nnP`
Year Constructed:
Contact: iM : c,% l Pa r, y C Q N C O rh M tr c.,{ j
Telephone:
Contractor Information:
n
Number of System Risers
Name: /T'IT 1f %cr Qr(j I Copy sent to:
Address: Jr'8'Ot3 c'[^.l`l?'d 17`p -t: /Owner Date
City: _UU I''4 1 Q(,c erj"re AHJ Date
State: _ ( f7 /Contractor Date
Telephone: ry 6V1— T33— 6510 NOTES:
1) For specific inspection, testing, andCALicense# _ maintenance requirements and information,
j see NFPA 25, 2002 Edition as amended by
California Code of Regulations, Title 19, §901
Performed by:
to §906. f Qi
Print) 2) Inspection Items may be performed by the
Owner In accordance with California Code of
Note: Contractor information may be pre - printed Regulations Title 19 904.1 a
Forms included with this report NFPA 25
Chapter Number of Forms N/A FAIL* PASS
Automatic Sprinkler System 5
Standpipe and Hose Systems 6
Private Water Supply System 7
Fire Pump 8
Water Storage Tank 9
Water Spray System 10
Foam Water Sprinkler System 11
See "Deficiencies and Comments" section at end of each respective form I
State Fire Marshal AES 1 March 21, 20
Inspection, Testing, and Maintenance Fire Sprinkler System Page 1 of 4
NFPA 25 Chapter 5 as amended by CCR, Title 19
Date of Inspection, Testing, Maintenance: System Riser ID:
Property Information:
Initial Static Pressure: (psi)
Name: (3 dQiWo..K Meal', c_a. P Ic-#-ZG.
Address: 9 336 Slo cX da, ls, -- IA - w j
Type 9f System: `o` A;rt1
l7 Wet Pipe N%
Dry Pipe
Preaction u l
M = Maintenance
A -O = After Operation
Deluge
MP. L q
City: S.K•er s ; e 1
Main Drain Test Results: Abbreviation Key:
I = Inspection
Initial Static Pressure: (psi) T = Test
Residual Pressure: u (psi)
M = Maintenance
A -O = After Operation
Oy
MI =Per Manufacturer's Instructions
Restored Static Pressure: (psi)
Item Activity Frequency Description NFPA 25 Fail N/A PassReference
1.1 1 Daily Preaction /Deluge Valves — Enclosure 12.4.3.1Weeklytemperature
1.2 1 Daily
Weekly Dry Pipe Valves — Enclosure temperature 12.4.4.1.1
1.3 1 Quarterly Gauges (Dry, Preaction, Deluge Systems) 5.2.4.2
5.2.4.3
1.4 1 Quarterly Control Valves 12.3.2.1
1-
01
1.5 1 Quarterly Alarm Devices 5.2.6
1.6 1 Quarterly Gauges (Wet Pipe Systems) 5.2.4.1
1.7 1 Quarterly Hydraulic nameplate 5.2.7
1.8 1 Quarterly Sprinklers 5.2.1
1.9 1 Quarterly Spare Sprinklers 5.2.1.3
1.10 1 Quarterly Fire Department Connections 12.7.1
1.11 1 Quarterly Alarm Valves — Exterior Inspection 12.4.1.1
1.12 1 Quarterly Preaction /Deluge Valves — Exterior Inspection 12.4.3.1.6
1.13 1 Quarterly Pressure Reducing Valves 12.5.1.1
1.14 1 Quarterly Dry Pipe Valves — Exterior Inspection 12.4.4.1.4
1.15 1 Quarterly Backflow Preventers 12.6.1
1.16 1 Annually Pipe and Fittings 5.2.2
1.17 1 Annually Buildings 5.2.5
State Fire Marshal AES 2 June 17, 2008
Inspection, Testing, and Maintenance Fire Sprinkler System Page 2 of 4
NFPA 25 Chapter 5 as amended by CCR Title 19
Date of Inspection, Testing, Maintenance: I System Riser ID:
Property Information:
NFPAn aRefere
Name: R;r G!w al Y, dv c.a., 17 oN,o,
Address: 9330 $oGiGd c„1 -4
Type o ystem: ° ,V qA±c %I1
Wet Pipe
Dry Pipe
PreactionJDeluge
1
E MPQ
City: Saxers e.1 d
5.2.3
Item Activity Frequency Description NFPAn aRefere Fail N/A Pass
1.18 1 Annually Hangers 5.2.3
1.19 1 Annually Seismic Braces 5.2.3
1.20 1 5 Years Hangers (Accessible concealed spaces) 5.2.3.3
1.21 1 5 Years Seismic Braces (Accessible concealed
spaces) 5.2.3.3
1.22 I 5 Years Pipe and Fittings (Accessible concealed
spaces) 5.2.2.3
1.23 1 5 Years Sprinklers (Accessible concealed spaces) 5.2.1.1.4
1.24 1 5 Years Alarm Valves — Interior Inspection 12.4.1.2
1.25 1 5 Years Alarm Valves - Strainers, filters, orifices 12.4.1.2
1.26 1 5 Years Check Valves — Interior Inspection 12.4.2.1
1.27 1 5 Years Preaction /Deluge Valves — Interior Inspection 12.4.3.1.7
1.28 1 5 Years Preaction /Deluge Valves - Strainers, filters,
orifices
12.4.3.1.8
1.29 1 5 Years Dry Pipe Valves — Interior Inspection 12.4.4.1.5
1.30 1 5 Years Dry Pipe Valves - Strainers, filters, orifices 12.4.4.1.6
2.1 T Annually Alarm Devices (90 Sec) 5.3.3
12.2.7
2.2 T Annually Main Drain Test (Enter.data on Page 1)
12.2.6
12.2.6.1
12.3.3.4
2.3 T Annually Antifreeze Test 5.3.4
2.4 T Annually Control Valve - Position 12.3.3.1
2.5 T Annually Control Valve — Operation 12.3.3.1
2.6 T Annually Supervisory ' 12.3.3.5
2.7 T Annually Preaction Valve — Priming Water 12.4.3.2.1
2.8 T Annually Preaction Valve — Low Air Pressure Alarm 12.4.3.2.10
State Fire Marshal AES 2 June 17, 2008
Inspection, Testing, and Maintenance Fire Sprinkler System Page 3 of 4
NFPA 25, Chapter 5 as amended by CCR Title 19
Date of Inspection, Testing, Maintenance: \I - Z 03.4 11 System Riser ID:
Property Information:
NFPA 25
Reference
Name: , VVStj -N1 k Medl IC41A 'P1rOVIAP -. Type of ystem: f CA4; 11MetPipe
Address: q'33 -3 ko so a.A Q, VA `
Dry Pipe rPreaction
T
Deluge 9. i SAPLF /REMPP;
City: Qo.hCE;!'S rrie. d
12.4.3.2.2
Item Activity Frequency Description NFPA 25
Reference Fail N/A Pass
2.9 T Annually Preaction Valve — Full Flow Trip Test 12.4.3.2.2
2.10 T Annually Dry Pipe Valve — Priming Water 12.4.4.2.1
2.11 T Annually Dry Pipe Valve — Low Air Pressure Alarm 12.4.4.2.6
2.12 T Annually Dry Pipe Valve — Quick - Opening Device 12.4.4.2.4
2.13 T Annually Dry Pipe Valve — Trip Test 12.4.4.2.2
2.14 T Annually Backflow Preventer Assemblies 12.6.2
2.15 T 3 Years Dry Pipe Valve — Full Flow Trip Test 12.4.4.2.2.2
2.16 T 5 Years Gauges 5.3.2
2.17 T 5 Years Pressure Reducing Valve 12.5.1.2
2.18 T 5 Years Fire Department Connection Backflush 12.7.4
2.19 T 5 Years Sprinklers — Extra High Temperature 5.3.1.1.1.3
2.20 T 5 Years Sprinklers — Corrosive environment or
corrosive water
5.3.1.1.2
2.21 T 10 Years Sprinklers - Dry 5.3.1.1.1.5
2.22 T 20 Years Sprinklers - Fast Response 5.3.1.1.1.2
2.23 T 50 Years Sprinklers 5.3.1.1.1
2.24 T 75 Years Sprinklers 75 years in service 5.3.1.1.1.4
2.25 T
Sprinklers manufactured prior to 1920 —
Replace
5.3.1.1.1.1
3.1 M Annually Control Valves 12.3.4
3.2 M Annually Preaction /Deluge Valves 12.4.3.3.2
3.3 M Annually Dry Pipe Valves /Quick- Opening Devices 12.4.4.3.2
3.4 M Annually Dry Pipe Valve — Low Point Drains 12.4.4.3.3
3.5 M 5 Years Obstruction Investigation Chapter 13
State Fire Marshal AES 2 jurie 1 /, cuUo
Item
Inspection, Testing, and Maintenance Fire Sprinkler System
NFPA 25 Chapter 5 as amended by CCR Title 19
Page 4 of 4
Date of Inspection, Testing, Maintenance: -- V) System Riser ID:
Property Information:
Name: R veirwgak Meoi G 0CAZ0.
Type of ystem: Type
Pipe
o "1
Address: ?jQ S .e, K `1 u! y
0 Dry Pipe
0 Preaction
D
O Deluge
Zl yj4EMA
City: !94J&qxS 91 Zia
See Continuation Page(s) _ Indicate the number of continuation pages)
o
FAILS
Z-2-113
Signature Date
Item
Deficiencies and Comments:
Deficiencies and Comments Item number must correspond to the Item number
of the Activit listed above:
1) ,, K ,
o A% 1
See Continuation Page(s) _ Indicate the number of continuation pages)
o
FAILS
Z-2-113
Signature Date
State Fire Marshal AES 2 June 17, 2008