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5 Year
Fire Department Connection
Piping Hydrostatic Test Report
CINTAS FIRE PROTECTION
710 NARRAGANSETT PARK DR
PAWTUCKET, RI 02861
USA
42861
READY TM
FOR THE WORKDAY
Inspection date: Inspector:
�nspec�ion Location
Facility / Customer Name. �;�C:}-SJ(,��l/ �(����,�� 5 - �rGSUoI �Z���S�� �?�-j r1C�
Street Address: /40 � �p
4 Cit, State, Zip Code: Ivp�.�h (A_vj�OVyMG`
� 'e.C—
CustamerPhone:�'(Z�•��� y�� E-Mail:
25�D
Inspection performed in accordance with
NFPA 25 Standard for the inspection, Testing, and Maintenance
of Wader-Based Fire Protection Systems, 2014 edition.
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FDC ConnectionType (Staff Siamese)
s
!Location of
i Connection Tested
1a a stern control valve Iosed riot to� �[� ? des.. n._ .'.
f hich Valve Was Closed _ " F
....... .. .... ...
}
FDC vis1ble and accessible, without damage and signs in place 13,7.1 Pas Fail a
Co �ling and wiveIs Free o damage and rotate smoothly (13.7.1 Pass Fail
- ..... .. ._... _.. . . ..;Caps, plugs and gaskets in place and free from damage 1 •7.1 Pass Fail
::Check valve clapper free from leaks and automatic drain valve in place and operating properly 1 . .1 Pass Fail
Interlor of the con n t[en free of ob tructions, 13 7.1 9 Pass Fail
Internal inspection of check valve-components operate properly, cleaned/repaired as needed 1 . . .1 Pass Fair
'Hydrostatic test results of piping from FD to check valve acceptable. 1 .7. P F��l
'Tirne Began Hydrostatic Test
a
Time Ended Hydrostatic Test
r i shown on gauge during testing.
If a control valve was closed during testing, record rain drain test results to verify water supply
Location of Drain Test Connection: 2
k
f connection in good condition and gauge operable(13.4.1.1) bass fal l
Exterior � ... . .
# l draulic name late if a licable,, securely attached...and is legible . . „ bass Falb
f Prrssur (psi) shown on the pressure gauge. 5
Pressure (psi)shown on Supply later pressure gauge. 1 . ,
2
:Residual Pressure with valve open 1 . . r
'Static Pressure after valve closed 1 . . E
[plain Drain Test Pressure less than 10% reduction in flog from original acceptance test or previous test # Pass Fail l
-.results _
.. _ _ Pass El
Fail
>:
Adequate drainage available 1 . .4)
is . . ..
lyres open when returned to service. 1 . .1.2.1 Pass �Fall
,:. Naive[ire status - a p - -'
Page 2 of
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tiabillitY,E'sel W-C-Statemgat;
The owner and/or designated representative acknowledges the responsibility of the operating condition of the component
parts at the time of this inspection. It is agreed that the inspection service provided by the Contractor as prescribed
herein is limited to performing a visual inspection anidlor routine testing, and any investigation or unscheduled testing,
modification, maintenance, repair, etc.., of the component parts is, not included as part of the inspection work performed.
It is further understood that all information contained herein is provided to the best of the knowledge of the party
providing such information.
107
Date:
Diatel-
Sir
g U
(Customer signature) (Technician;Signa ure)
USN, a
Tech *an Name
Page 3 of 3
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