B08_Attachment_6_Fire_Inspection_Documentation_0001.pdf

Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19

Property Information:

Name: Occupancy/Use:

Address: Construction Type:

City: No. Stories:

ZIP: Year Constructed:

Contact:

Telephone:

Contractor Information: Number of System Risers

Name: Copy sent to:

Address: Owner Date:

City: Fire AHJ Date:

State: Contractor Date:

Telephone:

NOTES:

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 edition as amended by California Code of Regulations, Title 19, §901 to §906.

2) Inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, §904.1(a)

CA License#:

Job #:

Performed by:

Check box for each system inspected and enter the number of forms used for inspection.

Check boxes (Fail or Pass) to indicate status of inspected system at end of inspection.

Forms Included with this Report NFPA 25 Chapter Number of Forms N/A Fail* Pass

Automatic Sprinkler System 5

Standpipe and Hose System 6

Private Water Supply System 7

Fire Pump 8

Water Storage Tank 9

Water Spray System 10

Foam Water Sprinkler System 11

Water Mist System 12

Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas) Yes No

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

AES 1 September 3, 2013

Water Spray Fixed System

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Inspection Report 1 of 4

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Address

City St. Zip

City License # Phone Contact Person SFM Job # Phone CSLB Misc.

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached:

INSPECTION, TESTING, AND MAINTENANCE

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference Date Comments Only P,F,N/A

Inspection

1.1 I Backflow Preventer Chapter 13

1.2 I Check Valves Chapter 13

1.3 I Control Valves (Sealed) Chapter 13

1.4 I Control Valves (Locked, Supervised) Chapter 13

1.5 I Deluge Valve

10.2.2, Chapter 13

1.6 I Detection Systems NFPA 72

1.7 I Detector Check Valves Chapter 13

1.8 I Drainage 10.2.8

1.9 I Electric Motor 10.2.9

Chapter 8

1.10 I Engine Drive 10.2.9

Chapter 8

1.11 I Fire Pump 10.2.9

Chapter 8

1.12 I Fittings 10.2.4, 10.2.4.1

1.13 I Fittings (Rubber Gasketed) 10.2.3.1, Annex

1.14 I Gravity Tanks 10.2.10, Chapter 9

1.15 I Hangers 10.2.4.2

1.16 I Heat (Deluge Valve House) 10.2.1.5

Chapter 13

1.17 I Nozzles

10.2.1.1, 10.2.1.2, 10.2.1.6, 10.2.5.1, 10.2.5.2

1.18 I Pipe

10.2.1.1, 10.2.1.2, 10.2.4, 10.2.4.1,

1.19 I Pressure Tank 10.2.10, Chapter 9

Form AES 7 Sept. 3, 2013

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Inspection Report 2 of 4

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Job #

City

INSPECTION, TESTING, AND MAINTENANCE

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference Date Comments Only P,F,N/A

1.20 I Steam Driver 10.2.9, Chapter 8

1.21 I Strainers 10.2.7

1.22 I Suction Tanks 10.2.10, Chapter 9

1.23 I Supports

10.2.1.1, 10.2.1.2, 10.2.4.2

1.24 I Water Flow Alarm Devices NFPA 72

1.25 I Water Supervisory Alarm Devices NFPA 72

1.26 I Supervisory Signal Devices

(Except Valve Supervisory Switches) NFPA 72

1.27 I Water Supply Piping 10.2.6.1

10.2.6.2

1.28 I UHSWSS-Detectors 10.4.2

1.29 I UHSWSS-Controllers 10.4.3

1.30 I UHSWSS-Valves 10.4.4

Test

2.0 T Backflow Preventer Chapter 13

2.1 T Check Valves Chapter 13

2.2 T Control Valves 13.3.3.1

2.3 T Deluge Valve 10.2.2, Chapter 13

2.4 T Detection Systems NFPA 72

2.5 T Detector Check Valve Chapter 13

2.6 T Electric Motor 10.2.0, Chapter 13

2.7 T Engine Drive 10.2.9, Chapter 8

2.8 T Fire Pump 10.2.9, Chapter 8

2.9 T Flushing Connection to Riser

(Part of Annual Test)

10.2.1.3, Section 10.3

2.10 T Gravity Tanks 10.2.10, Chapter 9

2.11 T Main Drain Test 13.3.3.4

2.12 T Manual Release 10.2.1.3, 10.3.6

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Inspection Report 3 of 4

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Job #

City

INSPECTION, TESTING, AND MAINTENANCE

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference Date Comments Only P,F,N/A

2.13 T Nozzles

10.2.1.3, 10.2.1.6, Section 10.3

2.14 T Pressure Tank Section 10.2, Chapter 9

2.15 T Steam Driver 10.2.9, Chapter 8

2.16 T Strainers 10.2.1.3, 10.2.1.7, 10.2.7

2.17 T Suction Tanks 10.2.10, Chapter 9

2.18 T Water Flow Alarm Chapter 5

2.19 T Valve Supervisory Signal Devices Chapter 13

2.20 T Supervisory Signal Devices

(Except Valve Supervisory Switches) 13.2.6.2

2.21 T Water Spray System Test 10.3, Chapter 13

2.22 T Water Supply Flow Test 7.3.1

2.23 T UHSWSS 10.4

Maintenance

3.0 M Backflow Preventer Chapter 13

3.1 M Check Valves Chapter 13

3.2 M Control Valves 10.2.1.4, Chapter 13

3.3 M Deluge Valve 10.2.2, Chapter 13

3.4 M Detection Systems NFPA 72

3.5 M Detector Check Valve Chapter 13

3.6 M Electric Motor 10.2.9, Chapter 8

3.7 M Engine Drive 10.2.9, Chapter 8

3.8 M Fire Pump 10.2.9, Chapter 8

3.9 M Gravity Tanks 10.2.10, Chapter 9

3.10 M Pressure Tanks 10.2.6, Chapter9

3.11 M Steam Driver 10.2.9, Chapter 8

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Inspection Report 4 of 4

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Job #

City

INSPECTION, TESTING, AND MAINTENANCE

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference Date Comments Only P,F,N/A

3.12 M Strainers 10.2.1.4, 10.2.1.6, 10.2.7

3.13 M Strainers - Baskets/Screen

10.2.1.4, 10.2.1.7, A10.2.7

3.14 M Suction Tanks 10.2.10, Chapter 9

3.15 M Water Spray System 10.2.1.4, Chapter 13

D = Deficiency C = Comment (Indicate type )

Item Date Riser D C Deficiencies and Comments Indicate all equipment, devices and parts that were repaired or replaced

Check here if additional Deficiencies and Comments are listed on Form AES 9.

See Correction Form AES 10 for corrected deficiencies.

Number attached:

Number attached:

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Print Name

Signature Date

3742 W. Gettysburg Ave., Ste 102 – Fresno CA 93722 – Office (559) 233-2008 – Fax (559) 233-2009

SALES REP K. Hernandez JOB # SV2407120074 SYSTEM LOCATION 10707 Valley Administration

CUSTOMER Yosemite National Park TECHNICIAN Dennis Binion

ADDRESS 4414 Hills Studio CONTACT Tim Modjeski

Call Security Office PHONE 303-819-9916

SYSTEM TYPE: FM200 HALON SAPPHIRE INERGEN PREACTION DATE:

X 8/12/24

CONTROL PANEL

CONTROL PANEL CONDITION INDICATOR LAMPS BATTERIES

Manufacturer/Model Normal Alarm Trouble Power Alarm Trouble Volts AH Pass Fail Date

Pyrotronics F F F F F F None

BATTERY CONDITION: None

MONITORED BY: Central Control TROUBLE ALARM SUPERVISORY DISCHARGE

INITIATING DEVICES

TYPE:

IONIZATION HSSD PHOTOELECTRIC MANUFACTURER MODEL:

F

A = OPERATIONAL B = DIRTY C = PHYSICAL DAMAGE

NOTIFICATION APPLIANCES

TYPE QUANTITY

OPERATES 1ST

ALARM

OPERATES 2ND

ALARM

OPERATES

DURING

DISCHARGE

FUNTIONAL

YES NO

HORN 1

STROBE

BELL

HORN/STROBE

DISCHARGE HEAD

DISCHARGE HEADS MAIN RESERVE

FUNCTIONAL FUNTIONAL

TYPE

YES NO YES NO

Not Connected

SALES REP K. Hernandez JOB # SV2407120074 SYSTEM LOCATION 10707 Valley Administration

CUSTOMER Yosemite National Park TECHNICIAN Dennis Binion

ADDRESS 4414 Hills Studio CONTACT Tim Modjeski

AGENT STORAGE CONTAINERS

SERIAL # PSI

AGENT

WGT

BOTTLE

TYPE

INITIATOR

DATE

DIP TUBE

LEVEL

AMBIENT

TEMP SERIAL # PSI

AGENT

WGT

BOTTLE

TYPE INITIATOR DATE

ATM 4732 380 482 Pyro N/A N/A 73

ATM 4735 380 482 Pyro N/A N/A 73

PARTS REPLACED

PART ID NUMBER QTY I PU SO

DETECTORS

LOCATION MODEL CEIL UFLR ATTIC DUCT

TYPE

LOCATION MODEL CEIL UFLR ATTIC DUCT

TYPE

SMOKE HEAT SMOKE HEAT

Front Room F

Back Room F

Center Room F

Visitor Room F

Entrance Hall F

SALES REP K. Hernandez JOB # SV2407120074 SYSTEM LOCATION 10707 Valley Administration

CUSTOMER Yosemite National Park TECHNICIAN Dennis Binion

ADDRESS 4414 Hills Studio CONTACT Tim Modjeski

Deficiencies and Comments

Indicate all equipment, devices and parts that were repaired or replaced

DEFECTS:

1 Nothing Was tied in, The System was completely deactivated

3 Not tested – tanks (2 qty) need to be Hydro Tested (date on tanks 1984)

SEQUENCE OF OPERATION:

Not tested – tanks need to be Hydro Tested (date on tanks 1984)

Tanks located under building – access is behind the building

ADDITIONAL NOTES:

Covers inside Building with nozzles in each room

Technician Signature Dennis Binion Date 8/12/2024

Inspection, Testing, and Maintenance Cover Sheet NFPA25 as amended by CCR, Title 19

Property Information:

Name: Occupancy/Use:

Address: Construction Type:

City: No. Stories:

ZIP: Year Constructed:

Contact:

Telephone:

Contractor Information: Number of System Risers

Name: Copy sent to:

Address: Owner Date:

City: Fire AHJ Date:

State: Contractor Date:

Telephone:

NOTES:

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011 edition as amended by California Code of Regulations, Title 19, §901 to §906.

2) Inspection items may be performed by the owner in accordance with California Code of Regulations, Title 19, §904.1(a)

CA License#:

Job #:

Performed by:

Check box for each system inspected and enter the number of forms used for inspection.

Check boxes (Fail or Pass) to indicate status of inspected system at end of inspection.

Forms Included with this Report NFPA 25 Chapter Number of Forms N/A Fail* Pass

Automatic Sprinkler System 5

Standpipe and Hose System 6

Private Water Supply System 7

Fire Pump 8

Water Storage Tank 9

Water Spray System 10

Foam Water Sprinkler System 11

Water Mist System 12

Concerns that are Not Deficiencies (i.e. Non-Sprinklered Areas) Yes No

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

AES 1 September 3, 2013

Wet Pipe Fire Sprinkler System

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report 1 of 3

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Address

City St. Zip

City License # Phone

Contact Person SFM Job # CSLB Misc.

Riser Information Main Drain Test (Annual) Riser No. Location Riser

Diameter Main Drain Diameter

Initial Static Pressure

Residual Pressure

Final Static Pressure P,F,N/A

This building has more than 5 risers. See additional AES 2.9 form attached. Number of AES 2.9 forms attached

Quarterly Inspections I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference

Date Date Date Date

1.1 I Control Valves – Identification Sign 13.3.1

1.2 I Control Valves – Inspection 13.3.2

1.3 I Waterflow Alarm Devices 5.2.5

1.4 I Supervisory Devices 5.2.5

1.5 I Gauges (Wet Pipe Systems) 5.2.4.1

1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi psi psi

1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi psi psi

1.8 I Pressure Readings Acceptable 5.2.4.1

1.9 I Hydraulic Design Information Sign

(For Hydraulically Designed Systems) 5.2.6

1.10 I General Information Sign

(Not Required for System prior to 2007 Edition of NFPA 13) 5.2.8

1.11 I Heat Tape 5.2.7

1.12 I Spare Sprinklers 5.2.1.4

1.13 I Fire Department Connections 13.7

1.14 I Alarm Valves – Exterior Inspection 13.4.1

1.15 I Pressure Reducing Valves 13.5.1.1

1.16 I Backflow Preventers 13.6.1

1.17 I Small Hose Connections - Hose Valve* 5.1.6, 13.5.2

13.5.5.1

1.18 I PRV – Fire Sprinkler Systems 13.5.1.1

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems.

Form AES 2.1 Sept. 3, 2013

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report 2 of 3

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Job #

City

ANNUAL INSPECTION, TESTING, AND MAINTENANCE

Include ALL Quarterly Inspections

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 25 CA ed.

Reference Date Comments Only P,F,N/A

1.19 I Sprinklers 5.2.1

1.20 I Buildings (Freeze Protection) 4.1.1.1 Owner’s Responsibility

1.21 I Pipe and Fittings 5.2.2

1.22 I Hangers 5.2.3

1.23 I Seismic Braces 5.2.3

2.1 T Field Service Test Required

(Send Report to Fire Code Official) 5.3.1 If REQUIRED, Enter 'F' until results are returned from Lab

2.2 T Recalled Sprinklers

If not present = Pass; If present = Fail

Title 19 904.1(c)

2.3 T Water Flow Alarm Devices

90 sec. maximum - (Enter Time )

5.3.3

13.2.6 sec.

2.4 T Main Drain Test

(Enter Data on Page 1 of this Form)

13.2.5 13.3.3.4

2.5 T Control Valve - Position 13.3.3.2

2.6 T Control Valve – Operation 13.3.3.1

2.7 T Supervisory Devices 13.3.3.5

2.8 T Backflow Preventer Assemblies 13.6.2

2.9 T Small Hose Connections*

w/PRV Hose Valves – Partial Flow Test

13.5.2.3 13.5.3.3

2.10 T PRV – Fire Sprinkler Systems 13.5.1.3

3.1 M Control Valves 13.3.4

3.2 M Small Hose Connections* 13.5.6.3

3.3 M

Obstruction Investigation required (If “Yes”, see Deficiencies and Comments Section for Results.)

14.3 Yes No

3.4 M System Returned to Service 4.5.3

Yes No

* Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III standpipe systems.

D = Deficiency C = Comment (Indicate type )

Item Date Riser D C Deficiencies and Comments Indicate all equipment, devices and parts that were repaired or replaced

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance

Quarterly and Annual Report 3 of 3

Property Information Contractor or Licensed Owner Information

Building Name Name Address Job #

City

D = Deficiency C = Comment (Indicate type )

Item Date Riser D C Deficiencies and Comments (cont.)

Indicate all equipment, devices and parts that were repaired or replaced

Check here if additional Deficiencies and Comments are listed on Form AES 9.

See Correction Form AES 10 for corrected deficiencies.

Number attached:

Number attached:

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Check box if Annual Inspection, Testing & Maintenance Items are Completed in the Indicated Quarter

Quarter 1st - Annual 2nd - Annual 3rd - Annual 4th - Annual

Date

Print Name

Signature

Fidel Chavez

Form AES 21 Sept. 3, 2013

Dry Chemical Pre-Engineered California Code of Regulations - Title 19 Semi-Annual

Fire Extinguishing System Inspection, Testing, and Maintenance Report

Property Information

Contractor or Licensed Owner Information

Building Name Yosemite NP Maint. Name HCI Systems

Address Tioga Rd Hwy 120 & 140 Address 3742 W Gettysburg Ave, Suite 102

El Portal Battery Storage City Fresno St. CA Zip 93722 City Yosemite NP License # 905493 Phone (559) 233-2008

Contact Person Tim Modjeski SFM Job # SV2407120074

Phone 303-819-9916 CSLB Misc.

System Information

Cylinder Size(s) 70 lb. Last Hydrostatic Test Date(s) 2005 Duct Size(s) 16" x 16" System Location R/S Exterior System Mfr. Pyro-Chem Model # Monarch Protected Area Type Hazmat Storage Dimensions 8' x 24' Fuel/Air Shut Off: Mechanical Electrical

Fixed Temperature Sensing Elements (Such as Fusible Links)

Quantity Temp Mfg Date

Install Quantity

Date Temp

Mfg Date

Install Date

2 280* 2024(NEW) 2024

Inspection, Testing and Maintenance

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item Description NFPA 17 CA ed.

Reference Date Comments Only P,F,N/A

1.1 I

Manual Actuators are Unobstructed (i.e. Remote Pull Station)

11.2.1.1(2) 8/12/24

P

1.2 I Tamper Indicators & Seals Intact 11.2.1.1(3) 8/12/24

1.3 I Maintenance Tag in Place

11.2.1.1(4)

CCR T-19 §906 8/12/24

1.4 I No Obvious Physical Damage 11.2.1.1(5) 8/12/24 P

1.5 I

Gauge Readings within Proper Limits (Stored Pressure)

11.2.1.1(6) 8/12/24

1.6 I Blow-Off Caps in Place & Undamaged 11.2.1.1(7) 8/12/24

1.7 I

Protected Equipment or Hazard Has Not Been Replaced, Modified or Relocated

11.2.1.1(8) 8/12/24 P

2.1 T

Automatic Detection, Manual Actuation, Shutdowns and Auxiliary Equipment Functioned Correctly 11.3.1.4 8/12/24

P

2.2 T Alarm Signals Functioned Correctly 11.3.1.4 8/12/24 N/A

2.3 T Releasing Devices Operable 11.3.1.4 8/12/24

3.1 M

All Agent Containers within Acceptable Hydrostatic Test Dates 11.5.1(1) 8/12/24

F

3.2 M

All Auxiliary Pressure Containers and/or Hose Assemblies within Acceptable Hydrostatic Test Dates

11.5.1(2)(3) 8/12/24

3.3 M Cartridge Weights within Acceptable Limits 11.3.1.1(2) 8/12/24 P

3.4 M Nozzles are Correct, Clean & Properly Aimed 11.3.1.1(2) 8/12/24 P

3.5 M Expellant Gas containers are Full and Free of Defects 11.3.1.1(2) 8/12/24 P

3.6 M Hose Assemblies Checked 11.3.1.1(2) 8/12/24

N/A

3.7 M Distribution Piping Unobstructed and Contiguous 11.3.1.1(3) 8/12/24 P

Form AES 21 Sept. 3, 2013

Dry Chemical Pre-Engineered California Code of Regulations - Title 19 Semi-Annual

Fire Extinguishing System Inspection, Testing, and Maintenance Report

Property Information

Contractor or Licensed Owner Information

Building Name Yosemite NP Maint. Name HCI Systems

Address Tioga Rd Hwy 120 & 140 Job # SV2407120074

City Yosemite NP

Inspection, Testing, and Maintenance

I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable

Item

Description NFPA 17 CA ed.

Reference Date Comments Only P,F,N/A

3.8 M

Dry Chemical is Not Caked

(Non-Pressurized) 11.3.1.1(4) 8/12/24

3.9 M No Signs of Corrosion or Damage to the Agent Cylinders 11.3.1.3 8/12/24

3.10 M

Fixed-Temperature Sensing Elements Maintained or Replaced 11.3.2 8/12/24

3.11 M

Dry Chemical is Not Caked (Stored Pressure Tank Every 6 Years) 11.3.1.2 8/12/24

D = Deficiency C = Comment (Indicate type )

Item Date Riser D C Deficiencies and Comments Indicate all equipment, devices and parts that were repaired or replaced

3.1 8/12/24 X

Hydrotest Due on system cylinder

3.2 8/12/24 X 16 gram CO2 Cart. needs to be replaced

No fan shutdowns , need to check with AHJ to find out if fans need to shut down

Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:

See Correction Form AES 10 for corrected deficiencies. Number attached:

I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this date by the company indicated above, in accordance with CCR Title 19 Sections 901 to 906 and that the equipment is fully operable except as noted in the “Deficiencies and Comments” section of this form.

Print Name Dennis Binion

Signature Dennis Binion Date: 8/12/24

23: [ P]