BLDG 20 5 Year Test 20190103 corrected.pdf

ffi FIFIE pHmrH#:Tt#N u uorporale:

710 West Stadlum Lane Sacramento, CA 95834 Phone (916) 641-7997

QA7) 642-7905

Fax (916) 641-0775

Email: mfo@maroueefire com

B Bay Area:

Phone (925) 691-0744

Fax (925) 691-0742

Contractor Lic #: CA 570970

NV 0073137

August 19,2019

U.S. Department of Veterans Affairs Northern California Health Care System 150 Muir Road Martinez, CA 94553

RE: VA Martinez Building 20 5-Year Fire Sprinkler lnspection

Dear Tim, MARQUEE FIRE PROTECTION conducted a 5-Year Fire Sprinkler lnspection at the VA in Martinez on Building20.

All deficiencies have been corrected except for replacing the fire sprinklers that failed UL Lab Testing from random samples that were obtained from each wing or zone of Buildin 920.

Currently the heads are anticipated to be replaced concurrently with the piping to bring the existing fire sprinkler system up to current NFPA 13 standards

Respectfully, MARQUEE FIRE PROTECTION a California corporation

-p^Jb*l*,*s" Dan Awtrey Project Manager

RAUEE

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

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 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:

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

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

5 Year 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 (See AES 2.1)

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

1.17 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.

Form AES 2.2 Sept. 3, 2013

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

Property Information Contractor or Licensed Owner Information

Building Name Name

Address Job #

City

ANNUAL INSPECTION, TESTING, AND MAINTENANCE

include ALL Quarterly Inspections (See AES 2.1)

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

3.1 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

Yes No

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 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

Form AES 2.2 Sept. 3, 2013

5 Year Report 3 of 3

Theresa Scott Signature

Corrective Action and Repairs Performed

California Code of Regulations - Title 19 Inspection, Testing, and Maintenance 1 of 1

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.

Item AES Form #

Date Found

Date Corrected

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

I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable.

Building Representative Technician

Signature Signature

Form AES 10 Sept. 3, 2013

Date Date

Theresa Scott Signature