B08_Attachment_8_Ranger_Club_Cover_Page_0002.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