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25 -7S INSPECTION, TESTING, AND MAINTENANCE OF WATER - BASED FIRE PROTECTION SYSTEMS
Inspection, Testing, and Maintenance Cover Sheet
I NFPA 25 as amended by CCR, Title 19
Property Information:
Name: Y" Occupancy /Use: CAC,o
01
Address: Construction Type: 13P
City: — No. Stories:
ARE
ZIP: Year Constructed:
pQ,
Contact:
Telephone:
Contractor Information: Number of System Risers
Jorgensen Company
Copy sent to:
2345 S. I ruftvale have., #1
Owner date
BakersfMd --
ire ANJ Date / —
CA 93303
Contractor Date
661 - 327 -4352
NOTES:
262995 1) For specific inspection, testing, and
maintenance requirements and, information,
see NFPA 25, 2002 Edition as amended by
Job # California Code of Regulations, Title 19, §901
to §906. A / Performed bv:
2) Inspection Items may be performed by thePrint)
Owner in accordance with California Code of
Regulations Title 19 §904.1(a)
Forms included with this report NFPA 25
Chapter Number of Forms NIA FAIL* PASS
Automatic Sprinkler System 5
Standpipe and Hose Systems g
Private Water Supply System 7
Fire Pump g
Water Storage Tank g
Water Spray System 10
0 Foam Water Sprinkler System 11
See "Deficiencies and Comments" section at end of each respective form.
State Fire Marshal AES 1 March 21, 2006