36C26118Q0577-0005002.pdf

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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:

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

5-Year 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

Initial Static Pressure

Residual

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:

5-Year INSPECTION, TESTING AND MAINTENANCE Includes ALL Quarterly and Annual Inspections, Tests, and Maintenance items

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

1.1 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 Hydraulic Design Information Sign

(For hydraulically designed systems) 5.2.6

1.7 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi

1.8 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi

1.9 I Pressure Readings Acceptable 5.2.4.1

1.10 I General Information Sign

(not required for system prior to 2007 Edition 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

Form AES 2.2 Sept. 3, 2013

Forms

Line

5 Year Report 2 of 3

Address Job #

ANNUAL INSPECTION, TESTING, AND MAINTENANCE

Include ALL Quarterly Inspections (See AES 2.1)

Item Description NFPA 25 CA ed.

Reference Date Comments Only P,F,N/A

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

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

1.20 I Sprinklers 5.2.1

1.21 I Sprinklers - Accessible Concealed Space 5.2.1.1.6

1.22 I Pipe and Fittings 5.2.2

1.23 I Pipe and Fittings - Accessible Concealed Space 5.2.2.3

1.24 I Hangers 5.2.3

1.25 I Hangers - Accessible Concealed Space 5.2.3.3

1.26 I Seismic Braces 5.2.3

1.27 I Seismic Braces - Accessible Concealed Space 5.2.3.3

1.28 I Unsprinklered Areas CFC 901.4 Yes No

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 secs max. 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

2.11 T Pressure Gauges - Calibration 5.3.2

2.12 T Small Hose Connections* 13.5.6.2.2

* 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.

include ALL Quarterly Inspections (See AES 2.1)

3.1 M Check Valves - Internal inspection 13.4.2

3.2 M Control Valves 13.3.4

3.3 M FDC - Backflush 14.3.2.3

14.3.2.4

3.4 M Internal Pipe Inspection - See Deficiencies and

Comments Section for Results. 14.2

Yes No

3.5 M Obstruction Investigation Required. If "Yes", see

Deficiencies and Comments Section for Results 14.3

3.6 M System Returned to Service 4.5.3

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:

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

Signature Date

Report 3 of 3

NFPA25FormAES1CoverSheet2013

NFPA25FormAES1CoverSheet2013

NFPA25FormAES2.2 5-YearWetPipe

NFPA25FormAES2.9MainDrain Test Continuation Form 2013

NFPA25FormAES2.2 5-YearWetPipe

NFPA25FormAES2.9MainDrain Test Continuation Form 2013

Address 1: 4951 Arroyo rd

Contact: Troy heart

Fire AHJ: Off

Contractor: On

5: 0

6: 0

7: 0

8: 0

9: 0

10: 0

11: 0

12: 0

Yes: Off

No: On

PropertyName: V.A. Hospital

PropertyZIP: 94550

PropertyCity: Livermore ca

ContactTelephone: 650-493-5000

DDOccupancyUse: [B]

DDConstructionType: [Type II-B]

NumberStories: 1

YrConstructed: 1992

AutoSprinkler: On

Standpipe: Off

PrivateWater: Off

FirePump: Off

WaterStorage: Off

WaterSpray: Off

Foam: Off

WaterMist: Off

Concerns: Off

ContractorName: Western states fire protection

ContractorAddress: 2489 technology dr

ContractorCity: Hayward

ContractorSTate: Ca

ContractorTelephone: 510-783-2400

CALicense:

JobNumber: RK1215

Inspector: Paul Hernandez

DDOwner: Off

OwnerDate:

0:

AHJDate:

ContractorDate: 05/01/17

Sprinkler NA:

0: Off

1: Yes

2: Yes

3: Yes

4: Yes

5: Yes

6: Yes

7: Yes

Sprinkler Fail:

0: Yes

1: Off

2: Off

3: Off

4: Off

5: Off

6: Off

7: Off

Sprinkler Pass:

0: Off

1: Off

2: Off

3: Off

4: Off

5: Off

6: Off

7: Off

License: 488359

Phone: 510-783-2400

SFM:

Contact PersonRow1: Troy heart

CSLB: 488359

Misc:

Riser NoRow1: 1

LocationRow1: lower floor in mechanical outside of building

Riser DiameterRow1: 4"

Main Drain DiameterRow1: 2"

Initial Static PressureRow1: 60

Residual PressureRow1: 55

Final Static PressureRow1: 60

P F NARow1: P

Riser NoRow2: 2

LocationRow2: Penthouse mechanical room

Riser DiameterRow2: 1 1/2"

Main Drain DiameterRow2: 1"

Initial Static PressureRow2: 0

Residual PressureRow2: 0

Final Static PressureRow2: 0

P F NARow2: P

Riser NoRow3:

LocationRow3:

Riser DiameterRow3:

Main Drain DiameterRow3:

Initial Static PressureRow3:

Residual PressureRow3:

Final Static PressureRow3:

P F NARow3:

Riser NoRow4:

LocationRow4:

Riser DiameterRow4:

Main Drain DiameterRow4:

Initial Static PressureRow4:

Residual PressureRow4:

Final Static PressureRow4:

P F NARow4:

Riser NoRow5:

LocationRow5:

Riser DiameterRow5:

Main Drain DiameterRow5:

Initial Static PressureRow5:

Residual PressureRow5:

Final Static PressureRow5:

P F NARow5:

This building has more than 5 risers See additional AES 29 form attached: Off

1331: 05/01/17

1332: 05/01/17

525: 05/01/17

525_2: 05/01/17

5241: 05/01/17

526: 05/01/17

5241_2: 05/01/17

5241_3: 05/01/17

5241_4: 05/01/17 psi5241:

528: 05/01/17 psi528:

527: 05/01/17 psi527:

5214: 05/01/17 psi5214:

137: 05/01/17 psi137: No debre

1341: 05/01/17 psi1341: Clean

13511: 05/01/17 psi13511:

1361: 05/01/17 psi1361:

Comments Only516 1352 13551:

Comments Only13511:

Owners Responsibility521:

Owners Responsibility52116:

Owners Responsibility522:

Owners Responsibility5223:

Owners Responsibility523:

Owners Responsibility5233:

Owners Responsibility523_2:

Owners Responsibility5233_2:

sec1325 13334:

sec13332:

sec13331: PIV does not shut sec13335: Done by others sec1362:

sec13523 13533:

sec13513:

sec532:

sec135622:

Date: 05/01/17

1334: 05/01/17

142: 05/01/17

143: 05/01/17

453: 05/01/17

ItemRow1: 3.3

DateRow1: 5/1/17

RiserRow1: 1

DRow1:

CRow1: C

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow1: Backflush was successful no debre found in the pipe.

ItemRow2: 2.6

DateRow2: 5/1/17

RiserRow2: 1

DRow2: D

CRow2:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow2: PIV does not work properly, head is not connected to stem for correct operation. Also no

ItemRow3:

DateRow3:

RiserRow3:

DRow3:

CRow3:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow3: Indicating sign inside PIV anymore,also after exercising the valve multiple times it will still not

ItemRow4:

DateRow4:

RiserRow4:

DRow4:

CRow4:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow4: Shut to isolate the system. PIV post needs to be replaced, the valve underground should be

ItemRow5:

DateRow5:

RiserRow5:

DRow5:

CRow5:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow5: Investigated a little more to insure it is not working properly before being replaced.

ItemRow6:

DateRow6:

RiserRow6:

DRow6:

CRow6:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow6:

ItemRow7:

DateRow7:

RiserRow7:

DRow7:

CRow7:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow7:

ItemRow8:

DateRow8:

RiserRow8:

DRow8:

CRow8:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow8:

ItemRow9:

DateRow9:

RiserRow9:

DRow9:

CRow9:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow9:

ItemRow10:

DateRow10:

RiserRow10:

DRow10:

CRow10:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow10:

ItemRow11:

DateRow11:

RiserRow11:

DRow11:

CRow11:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow11:

ItemRow12:

DateRow12:

RiserRow12:

DRow12:

CRow12:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow12:

ItemRow13:

DateRow13:

RiserRow13:

DRow13:

CRow13:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow13:

ItemRow14:

DateRow14:

RiserRow14:

DRow14:

CRow14:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow14:

City: Palo Alto ca

ZIP: 94540

State: Ca

Dropdown4: [P]

Dropdown20:

0: [P]

1: [N/A]

2: [NA]

Text21:

Text22:

Text23: Done by others

Text24: Done by others

Text25:

Text26:

Text27:

Text28:

Dropdown1:

5: [P]

6: [P]

7: [NA]

8: [NA]

9: [P]

10: [NA]

11: [NA]

12: [P]

13: [P]

14: [P]

15: [NA]

16: [P]

DD1:

17: [N/A]

18: [N/A]

19: [N/A]

20: [P]

21: [P]

22: [P]

23: [P]

24: [P]

25: [P]

26: [P]

27: [P]

DATE1:

17: 05/01/17

18: 05/01/17

19: 05/01/17

20: 05/01/17

21: 05/01/17

22: 05/01/17

23: 05/01/17

24: 05/01/17

25: 05/01/17

26: 05/01/17

27: 05/01/17

28: 05/01/17

DATE2:

1: 05/01/17

2: 05/01/17

3: 05/01/17

4: 05/01/17

5: 05/01/17

6: 05/01/17

7: 05/01/17

8: 05/01/17

9: 05/01/17

10: 05/01/17

11: 05/01/17

12: 05/01/17

DD2:

1: N/A

2: P

3: N/A

4: P

5: P

6: F

7: N/A

8: P

9: N/A

10: N/A

11: P

12: N/A

CB1:

28: No

Check Box31: Off

Check Box32: Off

Building Name: V.A. Hospital building #88

Address_2: 4951 Arroyo rd

Name: Western states fire protection

Job: RK1215

Date3:

3: 05/01/17

Text3:

1:

DD3:

1: [P]

2: [P]

3: [P]

4: [P]

5: [P]

6: [P]

CB3:

4: Yes cb3:

6: Yes

CBAdditional Deficiencies: Off

CBAES10: Off

DefNumberAttached:

AES10NumberAttached:

SignatureDate: 05/01/17

Contractor City: Hayward

Contractor Address: 2489 technology dr

Text2:

3:

2:

PrintName: Paul Hernandez

PropertyCity#1: Livermore ca

PropertyAddress2:

NumberAES2:

9:

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011

VA mountain view 1776 old middlefield road Mountain view ca 94043 Richard

(650) 621-0357

A1

Type I-B

Western states fire protection

2489 Technology dr

Hayward

Ca.

(510) 783-2400

RK1217

Paul Hernandez

✔ 10/23/17

✔ 0 ✔

0 ✔

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

488359

2489 technology dr

Hayward Ca

510-783-2400

Mountain view ca RK1217

Richard

1 Stairwell landing north end of building 3" 1 1/2" 65 55 65 P Stairwell landing north end of building 3" 1 1/2" 65 55 65 P

10/23/17 P

10/23/17

P

10/23/17 NA

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

Mountain view ca

10/23/17 N/A

10/23/17 No bracing on risers F

10/23/17 ✔

10/23/17 50 N/A

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

Mountain view ca

10/23/17 ✔ P

10/23/17 ✔ P

1.26 10/23/17 Both D No four way braceing at top of the risers nore riser manifold.

3.4 10/23/17 Both C Systems are only 5yrs old very clean inside pipes.

10/23/17 Both C No lock and chain on either risers, must add them to insure the operation of the system.

1.28 10/23/17 2 C Second floor lobby leading into office space there are two heads that are being

Obstructed from a glass wall that was installed so there is no coverage on the other side of the

Glass.either add two heads or take out at least '1-0 of the top of the glass wall so the sprinkler

Can cover the other side of the glass.

1.10 10/23/17 D No signage on the outside door leading to the stairwell indicating that the fire risers are inside,it

Took me 10 minutes to find the location of the risers, there is no access from the outside so

You must enter the building go up to the second floor and back down the stairwell to access the

Fire risers. Suggest putting a handle on the door leading into the stairwell.

Main Drain Test Continuation Form

Inspection, Testing, and Maintenance 1 of 1

Address Address

City St. Zip

City License # Phone

Contact Person SFM Job #

Riser Information Main Drain Test

Pressure P,F,N/A

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

Form AES 2.9 Sept. 3, 2013

Phone

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

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

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

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

NFPA25FormAES1CoverSheet2013

NFPA25FormAES1CoverSheet2013

NFPA25FormAES2.2 5-YearWetPipe

NFPA25FormAES2.9MainDrain Test Continuation Form 2013

NFPA25FormAES2.2 5-YearWetPipe

NFPA25FormAES2.9MainDrain Test Continuation Form 2013

Fire AHJ: Off

DDOwner: Off

This building has more than 5 risers See additional AES 29 form attached: Off cb3:

6: Yes

CBAdditional Deficiencies: Off

CBAES10: Off

CBCSLB: Off

CBSFM: Off

This building has more than 5 risers See additional AES 29 form attached#1: Off cb3#1:

6: Off

CBAdditional Deficiencies#1: Off

CBAES10#1: Off

CBCSLB#1: Off

CBSFM#1: Off

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011

V.A. Hospital Livermore #65

4951 Arroyo ave Livermore ca

MOD

B

Type II-B

Hayward

Ca

(510) 783-2400

RK1215

✔ 10/18/17

✔ 0 ✔

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

V.A. Hospital building #65

4951 Arroyo rd

Hayward Ca 94540

510-783-2400

Livermore ca RK1215

MOD

1 Back side of building 4" 2" 55 50 55 P

10/18/17 P

10/18/17 Done by others N/A

10/18/17 Done by others NA

10/18/17

P

10/18/17 NA

10/17/17 P

10/17/17 No debre P

10/18/17 Clean P

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

10/18/17 N/A

10/18/17 ✔

10/18/17 Done by others N/A

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

10/18/17 ✔ P

10/18/17 ✔ P

1.20 10/18/17 1 C Uprights and pendants throughout the shop have heads over 50yrs old, suggest to replace

Instead of testing 3%. Total uprights 75 total pendants 10

1.28 10/18/17 1 D Duct near inspectors test needs a head under it, duct is over 4' so required to install

Sprinkler heard for propor coverage. Old central solder link heads in shop now.

10/18/17

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

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

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

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

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

NFPA25FormAES1CoverSheet2013

NFPA25FormAES1CoverSheet2013

NFPA25FormAES2.2 5-YearWetPipe

NFPA25FormAES2.9MainDrain Test Continuation Form 2013

NFPA25FormAES2.2 5-YearWetPipe

NFPA25FormAES2.9MainDrain Test Continuation Form 2013

Fire AHJ: Off

DDOwner: Off cb3:

6: Yes

CBAdditional Deficiencies: Off

CBAES10: Off

CBCSLB: Off

CBSFM: Off

This building has more than 5 risers See additional AES 29 form attached#1: Off cb3#1:

6: Off

CBAdditional Deficiencies#1: Off

CBAES10#1: Off

CBCSLB#1: Off

CBSFM#1: Off

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011

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

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

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

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

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

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

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

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

NFPA25FormAES1CoverSheet2013

NFPA25FormAES1CoverSheet2013

NFPA25FormAES2.2 5-YearWetPipe

NFPA25FormAES2.9MainDrain Test Continuation Form 2013

NFPA25FormAES2.2 5-YearWetPipe

NFPA25FormAES2.9MainDrain Test Continuation Form 2013

Address 1: 795 Willow Rd

Contact: Garry Deshields

Fire AHJ: Off

Contractor: On

5: 0

6: 0

7: 0

8: 0

9: 0

10: 0

11: 0

12: 0

Yes: On

No: Off

PropertyName: VA hospital building #347

PropertyZIP: 94025

PropertyCity: Menlo Park

ContactTelephone: (650)208-7029

DDOccupancyUse: [B]

DDConstructionType: [Type II-B]

NumberStories:

YrConstructed:

AutoSprinkler: On

Standpipe: Off

PrivateWater: Off

FirePump: Off

WaterStorage: Off

WaterSpray: Off

Foam: Off

WaterMist: Off

Concerns: Off

ContractorName: Western States Fire Protection

ContractorAddress: 2489 Technology Dr

ContractorCity: Hayward

ContractorSTate: Ca

ContractorTelephone: 510-783-2400

CALicense: 488359

JobNumber: RK1214

Inspector: Rafael Escobar

DDOwner: Off

OwnerDate:

0:

AHJDate:

ContractorDate: 04/18/17

Sprinkler NA:

0: Off

1: Yes

2: Yes

3: Yes

4: Yes

5: Yes

6: Yes

7: Yes

Sprinkler Fail:

0: Yes

1: Off

2: Off

3: Off

4: Off

5: Off

6: Off

7: Off

Sprinkler Pass:

0: Off

1: Off

2: Off

3: Off

4: Off

5: Off

6: Off

7: Off

License: 488359

Phone: 510-783-2400

SFM:

Contact PersonRow1: Garry Deshields

CSLB:

Misc:

Riser NoRow1: 1

LocationRow1: Next to front desk 1st floor in control valve closet

Riser DiameterRow1: 4"

Main Drain DiameterRow1: 2"

Initial Static PressureRow1: 55

Residual PressureRow1: 40

Final Static PressureRow1: 55

P F NARow1: P

Riser NoRow2: 2

LocationRow2: Next to front desk 1st floor in control valve closet

Riser DiameterRow2: 4"

Main Drain DiameterRow2: 2"

Initial Static PressureRow2: 55

Residual PressureRow2: 40

Final Static PressureRow2: 55

P F NARow2: P

Riser NoRow3: 3

LocationRow3: 2nd floor in control valve closet by elevator

Riser DiameterRow3: 4"

Main Drain DiameterRow3: 2"

Initial Static PressureRow3: 55

Residual PressureRow3: 40

Final Static PressureRow3: 55

P F NARow3: P

Riser NoRow4: 4

LocationRow4: 2nd floor in control valve closet by elevator

Riser DiameterRow4: 4"

Main Drain DiameterRow4: 2"

Initial Static PressureRow4: 55

Residual PressureRow4: 40

Final Static PressureRow4: 55

P F NARow4: P

Riser NoRow5:

LocationRow5:

Riser DiameterRow5:

Main Drain DiameterRow5:

Initial Static PressureRow5:

Residual PressureRow5:

Final Static PressureRow5:

P F NARow5:

This building has more than 5 risers See additional AES 29 form attached: Off

1331: 04/18/17

1332: 04/18/17

525: 04/18/17

525_2: 04/18/17

5241: 04/18/17

526: 04/18/17

5241_2: 04/18/17

5241_3: 04/18/17

5241_4: 04/18/17 psi5241:

528: 04/18/17 psi528:

527: 04/18/17 psi527:

5214: 04/18/17 psi5214:

137: 04/18/17 psi137:

1341: 04/18/17 psi1341:

13511: 04/18/17 psi13511:

1361: 04/18/17 psi1361:

Comments Only516 1352 13551:

Comments Only13511:

Owners Responsibility521:

Owners Responsibility52116:

Owners Responsibility522:

Owners Responsibility5223:

Owners Responsibility523:

Owners Responsibility5233:

Owners Responsibility523_2:

Owners Responsibility5233_2:

sec1325 13334:

sec13332:

sec13331:

sec13335:

sec1362:

sec13523 13533:

sec13513:

sec532:

sec135622:

Date: 04/18/17

1334: 04/18/17

142: 04/18/17

143: 04/18/17

453: 04/18/17

ItemRow1: 1.20

DateRow1: 4/18/17

RiserRow1: 1

DRow1: X

CRow1: X

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow1: No access to rooms A207,A208,A204,A209,A113,D223,D224,D219,D225,D230,D231,E209

ItemRow2:

DateRow2:

RiserRow2:

DRow2:

CRow2:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow2: E210,G232,E119,E118,E117,D131,A111,A112,A108,A107,A106A

ItemRow3:

DateRow3:

RiserRow3:

DRow3:

CRow3:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow3:

ItemRow4:

DateRow4: 4/18/17

RiserRow4:

DRow4:

CRow4: C

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow4: Central 804A quick response year 1999 chrome 155 1/2" pendants throughout the building

ItemRow5:

DateRow5: 4/18/17

RiserRow5:

DRow5:

CRow5: C

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow5: Central 784A quick response year 1994 155 1/2" brass uprights throughout the building

ItemRow6:

DateRow6:

RiserRow6:

DRow6:

CRow6:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow6:

ItemRow7:

DateRow7:

RiserRow7:

DRow7:

CRow7:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow7:

ItemRow8:

DateRow8:

RiserRow8:

DRow8:

CRow8:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow8:

ItemRow9:

DateRow9:

RiserRow9:

DRow9:

CRow9:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow9:

ItemRow10:

DateRow10:

RiserRow10:

DRow10:

CRow10:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow10:

ItemRow11:

DateRow11:

RiserRow11:

DRow11:

CRow11:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow11:

ItemRow12:

DateRow12:

RiserRow12:

DRow12:

CRow12:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow12:

ItemRow13:

DateRow13:

RiserRow13:

DRow13:

CRow13:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow13:

ItemRow14:

DateRow14:

RiserRow14:

DRow14:

CRow14:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow14:

City: Menlo Park

ZIP: 94545

State: Ca

Dropdown4: [P]

Dropdown20:

0: [P]

1: [N/A]

2: [P]

Text21:

Text22:

Text23: Already tested by others

Text24:

Text25:

Text26:

Text27: 55

Text28: 55

Dropdown1:

5: [P]

6: [P]

7: [P]

8: [P]

9: [P]

10: [P]

11: [NA]

12: [P]

13: [P]

14: [P]

15: [NA]

16: [P]

DD1:

17: [N/A]

18: [N/A]

19: [N/A]

20: [F]

21: [P]

22: [P]

23: [P]

24: [P]

25: [P]

26: [P]

27: [P]

DATE1:

17: 04/18/17

18: 04/18/17

19: 04/18/17

20: 04/18/17

21: 04/18/17

22: 04/18/17

23: 04/18/17

24: 04/18/17

25: 04/18/17

26: 04/18/17

27: 04/18/17

28: 04/18/17

DATE2:

1: 04/18/17

2: 04/18/17

3: 04/18/17

4: 04/18/17

5: 04/18/17

6: 04/18/17

7: 04/18/17

8: 04/18/17

9: 04/18/17

10: 04/18/17

11: 04/18/17

12: 04/18/17

DD2:

1: P

2: P

3: N/A

4: P

5: P

6: P

7: P

8: P

9: N/A

10: N/A

11: P

12: N/A

CB1:

28: No

Check Box31: Off

Check Box32: Off

Building Name: VA Hospital Building #347

Address_2: 795 Willow Rd

Name: Western States Fire Protection

Job: RK1214

Date3:

3: 04/18/17

Text3:

1:

DD3:

1: [P]

2: [P]

3: [P]

4: [P]

5: [P]

6: [P]

CB3:

4: Yes cb3:

6: Yes

CBAdditional Deficiencies: Off

CBAES10: Off

DefNumberAttached:

AES10NumberAttached:

SignatureDate: 04/18/17

Contractor City: Hayward

Contractor Address: 2489 technology dr

Text2:

3:

2:

PrintName: Rafael Escobar

PropertyCity#1: Menlo Park

PropertyAddress2:

NumberAES2:

9:

Building Name#1:

Name#1:

License#1:

Phone#1:

SFM#1:

Job#1:

Contact PersonRow1#1:

CSLB#1:

Misc#1:

Riser NoRow1#1:

LocationRow1#1:

Riser DiameterRow1#1:

Main Drain DiameterRow1#1:

Initial Static PressureRow1#1:

Residual PressureRow1#1:

Final Static PressureRow1#1:

Riser NoRow2#1:

LocationRow2#1:

Riser DiameterRow2#1:

Main Drain DiameterRow2#1:

Initial Static PressureRow2#1:

Residual PressureRow2#1:

Final Static PressureRow2#1:

Riser NoRow3#1:

LocationRow3#1:

Riser DiameterRow3#1:

Main Drain DiameterRow3#1:

Initial Static PressureRow3#1:

Residual PressureRow3#1:

Final Static PressureRow3#1:

Riser NoRow4#1:

LocationRow4#1:

Riser DiameterRow4#1:

Main Drain DiameterRow4#1:

Initial Static PressureRow4#1:

Residual PressureRow4#1:

Final Static PressureRow4#1:

Riser NoRow5#1:

LocationRow5#1:

Riser DiameterRow5#1:

Main Drain DiameterRow5#1:

Initial Static PressureRow5#1:

Residual PressureRow5#1:

Final Static PressureRow5#1:

Riser NoRow6:

LocationRow6:

Riser DiameterRow6:

Main Drain DiameterRow6:

Initial Static PressureRow6:

Residual PressureRow6:

Final Static PressureRow6:

Riser NoRow7:

LocationRow7:

Riser DiameterRow7:

Main Drain DiameterRow7:

Initial Static PressureRow7:

Residual PressureRow7:

Final Static PressureRow7:

Riser NoRow8:

LocationRow8:

Riser DiameterRow8:

Main Drain DiameterRow8:

Initial Static PressureRow8:

Residual PressureRow8:

Final Static PressureRow8:

Riser NoRow9:

LocationRow9:

Riser DiameterRow9:

Main Drain DiameterRow9:

Initial Static PressureRow9:

Residual PressureRow9:

Final Static PressureRow9:

Riser NoRow10:

LocationRow10:

Riser DiameterRow10:

Main Drain DiameterRow10:

Initial Static PressureRow10:

Residual PressureRow10:

Final Static PressureRow10:

Riser NoRow11:

LocationRow11:

Riser DiameterRow11:

Main Drain DiameterRow11:

Initial Static PressureRow11:

Residual PressureRow11:

Final Static PressureRow11:

Riser NoRow12:

LocationRow12:

Riser DiameterRow12:

Main Drain DiameterRow12:

Initial Static PressureRow12:

Residual PressureRow12:

Final Static PressureRow12:

Riser NoRow13:

LocationRow13:

Riser DiameterRow13:

Main Drain DiameterRow13:

Initial Static PressureRow13:

Residual PressureRow13:

Final Static PressureRow13:

Riser NoRow14:

LocationRow14:

Riser DiameterRow14:

Main Drain DiameterRow14:

Initial Static PressureRow14:

Residual PressureRow14:

Final Static PressureRow14:

Riser NoRow15:

LocationRow15:

Riser DiameterRow15:

Main Drain DiameterRow15:

Initial Static PressureRow15:

Residual PressureRow15:

Final Static PressureRow15:

Riser NoRow16:

LocationRow16:

Riser DiameterRow16:

Main Drain DiameterRow16:

Initial Static PressureRow16:

Residual PressureRow16:

Final Static PressureRow16:

Riser NoRow17:

LocationRow17:

Riser DiameterRow17:

Main Drain DiameterRow17:

Initial Static PressureRow17:

Residual PressureRow17:

Final Static PressureRow17:

Riser NoRow18:

LocationRow18:

Riser DiameterRow18:

Main Drain DiameterRow18:

Initial Static PressureRow18:

Residual PressureRow18:

Final Static PressureRow18:

Riser NoRow19:

LocationRow19:

Riser DiameterRow19:

Main Drain DiameterRow19:

Initial Static PressureRow19:

Residual PressureRow19:

Final Static PressureRow19:

Riser NoRow20:

LocationRow20:

Riser DiameterRow20:

Main Drain DiameterRow20:

Initial Static PressureRow20:

Residual PressureRow20:

Final Static PressureRow20:

Print Name:

PropertyAddress:

Address:

City#1:

STate:

ZIP#1:

SignatureDate#1:

PropertyCity#2:

CBCSLB: Off

CBSFM: Off

DD1#1:

0: [ ]

1: [ ]

2: [ ]

3: [ ]

4: [ ]

5: [ ]

6: [ ]

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19: [ ]

PropertyAddress2#1:

PropertyPhone:

License#2:

Phone#2:

SFM#2:

Contact PersonRow1#2:

CSLB#2:

Misc#2:

Riser NoRow1#2:

LocationRow1#2:

Riser DiameterRow1#2:

Main Drain DiameterRow1#2:

Initial Static PressureRow1#2:

Residual PressureRow1#2:

Final Static PressureRow1#2:

P F NARow1#1:

Riser NoRow2#2:

LocationRow2#2:

Riser DiameterRow2#2:

Main Drain DiameterRow2#2:

Initial Static PressureRow2#2:

Residual PressureRow2#2:

Final Static PressureRow2#2:

P F NARow2#1:

Riser NoRow3#2:

LocationRow3#2:

Riser DiameterRow3#2:

Main Drain DiameterRow3#2:

Initial Static PressureRow3#2:

Residual PressureRow3#2:

Final Static PressureRow3#2:

P F NARow3#1:

Riser NoRow4#2:

LocationRow4#2:

Riser DiameterRow4#2:

Main Drain DiameterRow4#2:

Initial Static PressureRow4#2:

Residual PressureRow4#2:

Final Static PressureRow4#2:

P F NARow4#1:

Riser NoRow5#2:

LocationRow5#2:

Riser DiameterRow5#2:

Main Drain DiameterRow5#2:

Initial Static PressureRow5#2:

Residual PressureRow5#2:

Final Static PressureRow5#2:

P F NARow5#1:

This building has more than 5 risers See additional AES 29 form attached#1: Off

1331#1:

1332#1:

525#1:

525_2#1:

5241#1:

526#1:

5241_2#1:

5241_3#1:

5241_4#1:

psi5241#1:

528#1:

psi528#1:

527#1:

psi527#1:

5214#1:

psi5214#1:

137#1:

psi137#1:

1341#1:

psi1341#1:

13511#1:

psi13511#1:

1361#1:

psi1361#1:

Comments Only516 1352 13551#1:

Comments Only13511#1:

Owners Responsibility521#1:

Owners Responsibility52116#1:

Owners Responsibility522#1:

Owners Responsibility5223#1:

Owners Responsibility523#1:

Owners Responsibility5233#1:

Owners Responsibility523_2#1:

Owners Responsibility5233_2#1:

sec1325 13334#1:

sec13332#1:

sec13331#1:

sec13335#1:

sec1362#1:

sec13523 13533#1:

sec13513#1:

sec532#1:

sec135622#1:

Date#1:

1334#1:

142#1:

143#1:

453#1:

ItemRow1#1:

DateRow1#1:

RiserRow1#1:

DRow1#1:

CRow1#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow1#1:

ItemRow2#1:

DateRow2#1:

RiserRow2#1:

DRow2#1:

CRow2#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow2#1:

ItemRow3#1:

DateRow3#1:

RiserRow3#1:

DRow3#1:

CRow3#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow3#1:

ItemRow4#1:

DateRow4#1:

RiserRow4#1:

DRow4#1:

CRow4#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow4#1:

ItemRow5#1:

DateRow5#1:

RiserRow5#1:

DRow5#1:

CRow5#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow5#1:

ItemRow6#1:

DateRow6#1:

RiserRow6#1:

DRow6#1:

CRow6#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow6#1:

ItemRow7#1:

DateRow7#1:

RiserRow7#1:

DRow7#1:

CRow7#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow7#1:

ItemRow8#1:

DateRow8#1:

RiserRow8#1:

DRow8#1:

CRow8#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow8#1:

ItemRow9#1:

DateRow9#1:

RiserRow9#1:

DRow9#1:

CRow9#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow9#1:

ItemRow10#1:

DateRow10#1:

RiserRow10#1:

DRow10#1:

CRow10#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow10#1:

ItemRow11#1:

DateRow11#1:

RiserRow11#1:

DRow11#1:

CRow11#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow11#1:

ItemRow12#1:

DateRow12#1:

RiserRow12#1:

DRow12#1:

CRow12#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow12#1:

ItemRow13#1:

DateRow13#1:

RiserRow13#1:

DRow13#1:

CRow13#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow13#1:

ItemRow14#1:

DateRow14#1:

RiserRow14#1:

DRow14#1:

CRow14#1:

Deficiencies and Comments Indicate all equipment devices and parts that were repaired or replacedRow14#1:

City#2:

ZIP#2:

State#1:

Dropdown4#1: [ ]

Dropdown20#1:

0: [ ]

1: [ ]

2: [ ]

Text21#1:

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Dropdown1#1:

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DD1#2:

17: [ ]

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DATE1#1:

17:

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28:

DATE2#1:

1:

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DD2#1:

1:

2:

3:

4:

5:

6:

7:

8:

9:

10:

11:

12:

CB1#1:

28: Off

Check Box31#1: Off

Check Box32#1: Off

Building Name#2:

Address_2#1:

Name#2:

Job#2:

Date3#1:

3:

Text3#1:

1:

DD3#1:

1: [ ]

2: [ ]

3: [ ]

4: [ ]

5: [ ]

6: [ ]

CB3#1:

4: Off cb3#1:

6: Off

CBAdditional Deficiencies#1: Off

CBAES10#1: Off

DefNumberAttached#1:

AES10NumberAttached#1:

SignatureDate#2:

Contractor City#1:

Contractor Address#1:

Text2#1:

3:

2:

PrintName#1:

PropertyCity#3:

PropertyAddress2#2:

NumberAES2#1:

9:

Building Name#3:

Name#3:

License#3:

Phone#3:

SFM#3:

Job#3:

Contact PersonRow1#3:

CSLB#3:

Misc#3:

Riser NoRow1#3:

LocationRow1#3:

Riser DiameterRow1#3:

Main Drain DiameterRow1#3:

Initial Static PressureRow1#3:

Residual PressureRow1#3:

Final Static PressureRow1#3:

Riser NoRow2#3:

LocationRow2#3:

Riser DiameterRow2#3:

Main Drain DiameterRow2#3:

Initial Static PressureRow2#3:

Residual PressureRow2#3:

Final Static PressureRow2#3:

Riser NoRow3#3:

LocationRow3#3:

Riser DiameterRow3#3:

Main Drain DiameterRow3#3:

Initial Static PressureRow3#3:

Residual PressureRow3#3:

Final Static PressureRow3#3:

Riser NoRow4#3:

LocationRow4#3:

Riser DiameterRow4#3:

Main Drain DiameterRow4#3:

Initial Static PressureRow4#3:

Residual PressureRow4#3:

Final Static PressureRow4#3:

Riser NoRow5#3:

LocationRow5#3:

Riser DiameterRow5#3:

Main Drain DiameterRow5#3:

Initial Static PressureRow5#3:

Residual PressureRow5#3:

Final Static PressureRow5#3:

Riser NoRow6#1:

LocationRow6#1:

Riser DiameterRow6#1:

Main Drain DiameterRow6#1:

Initial Static PressureRow6#1:

Residual PressureRow6#1:

Final Static PressureRow6#1:

Riser NoRow7#1:

LocationRow7#1:

Riser DiameterRow7#1:

Main Drain DiameterRow7#1:

Initial Static PressureRow7#1:

Residual PressureRow7#1:

Final Static PressureRow7#1:

Riser NoRow8#1:

LocationRow8#1:

Riser DiameterRow8#1:

Main Drain DiameterRow8#1:

Initial Static PressureRow8#1:

Residual PressureRow8#1:

Final Static PressureRow8#1:

Riser NoRow9#1:

LocationRow9#1:

Riser DiameterRow9#1:

Main Drain DiameterRow9#1:

Initial Static PressureRow9#1:

Residual PressureRow9#1:

Final Static PressureRow9#1:

Riser NoRow10#1:

LocationRow10#1:

Riser DiameterRow10#1:

Main Drain DiameterRow10#1:

Initial Static PressureRow10#1:

Residual PressureRow10#1:

Final Static PressureRow10#1:

Riser NoRow11#1:

LocationRow11#1:

Riser DiameterRow11#1:

Main Drain DiameterRow11#1:

Initial Static PressureRow11#1:

Residual PressureRow11#1:

Final Static PressureRow11#1:

Riser NoRow12#1:

LocationRow12#1:

Riser DiameterRow12#1:

Main Drain DiameterRow12#1:

Initial Static PressureRow12#1:

Residual PressureRow12#1:

Final Static PressureRow12#1:

Riser NoRow13#1:

LocationRow13#1:

Riser DiameterRow13#1:

Main Drain DiameterRow13#1:

Initial Static PressureRow13#1:

Residual PressureRow13#1:

Final Static PressureRow13#1:

Riser NoRow14#1:

LocationRow14#1:

Riser DiameterRow14#1:

Main Drain DiameterRow14#1:

Initial Static PressureRow14#1:

Residual PressureRow14#1:

Final Static PressureRow14#1:

Riser NoRow15#1:

LocationRow15#1:

Riser DiameterRow15#1:

Main Drain DiameterRow15#1:

Initial Static PressureRow15#1:

Residual PressureRow15#1:

Final Static PressureRow15#1:

Riser NoRow16#1:

LocationRow16#1:

Riser DiameterRow16#1:

Main Drain DiameterRow16#1:

Initial Static PressureRow16#1:

Residual PressureRow16#1:

Final Static PressureRow16#1:

Riser NoRow17#1:

LocationRow17#1:

Riser DiameterRow17#1:

Main Drain DiameterRow17#1:

Initial Static PressureRow17#1:

Residual PressureRow17#1:

Final Static PressureRow17#1:

Riser NoRow18#1:

LocationRow18#1:

Riser DiameterRow18#1:

Main Drain DiameterRow18#1:

Initial Static PressureRow18#1:

Residual PressureRow18#1:

Final Static PressureRow18#1:

Riser NoRow19#1:

LocationRow19#1:

Riser DiameterRow19#1:

Main Drain DiameterRow19#1:

Initial Static PressureRow19#1:

Residual PressureRow19#1:

Final Static PressureRow19#1:

Riser NoRow20#1:

LocationRow20#1:

Riser DiameterRow20#1:

Main Drain DiameterRow20#1:

Initial Static PressureRow20#1:

Residual PressureRow20#1:

Final Static PressureRow20#1:

Print Name#1:

PropertyAddress#1:

Address#1:

City#3:

STate#1:

ZIP#3:

SignatureDate#3:

PropertyCity#4:

CBCSLB#1: Off

CBSFM#1: Off

DD1#3:

0: [ ]

1: [ ]

2: [ ]

3: [ ]

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PropertyAddress2#3:

PropertyPhone#1:

1) For specific inspection, testing, and maintenance requirements and information, see NFPA 25, 2011

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

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

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

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

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

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

Indicate all equipment, devices and parts tha