Form Aes 2.3 - California Code Of Regulations - Title 19 Inspection, Testing, And Maintenance - Quarterly And Annual Report Page 2

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Dry Pipe
California Code of Regulations - Title 19
Quarterly and
2 of 3
Fire Sprinkler System
Inspection, Testing, and Maintenance
Annual Report
Property Information
Contractor or Licensed Owner Information
Building Name
Name
Address
Job #
City
ANNUAL INSPECTION, TESTING, AND MAINTENANCE
Include ALL Quarterly Inspections (See Previous Page)
I = Inspection
T = Test
M = Maintenance
P = Pass
F = Fail
N/A = Not Applicable
NFPA 25 CA ed.
Item
Description
Date
Comments Only
P,F,N/A
Reference
Buildings (Freeze Protection)
1.17
I
4.1.1.1
Owner’s Responsibility
1.18
I
Sprinklers
5.2.1
1.19
Pipe and Fittings
5.2.2
I
1.20
I
Hangers
5.2.3
1.21
I
Seismic Braces
5.2.3
1.22
I
Small Hose Connections*
13.5.6.2.2
If REQUIRED, Enter 'F' until
Field Service Test Required
2.1
T
5.3.1
(Send Report to Fire Code Official)
results are returned from Lab
Title 19
Recalled Sprinklers
2.2
T
904.1(c)
If not present = Pass;
If present = Fail
Water Flow Alarm Devices
5.3.3
2.3
T
sec.
90 sec. maximum - (Enter Time )
13.2.6
Main Drain Test
13.2.5
2.4
T
13.3.3.4
(Enter data on Page 1 of this form)
2.5
T
Priming Water Level Test
13.4.4.2.1
13.4.4.2.2
Dry Pipe Valve Trip Test
2.6
T
13.4.4.2.2.3
(Partial trip test is acceptable)
13.4.4.1.5
2.7
T
Valve Trip Time
13.4.4.2.5.2
sec.
2.8
T
Trip Air Pressure
13.4.4.2.5.1
psi
2.9
T
Quick-Opening Device Test
13.4.4.2.4
2.10
T
Low Air Pressure Alarm Test
13.4.4.2.6
2.11
T
Low Temperature Alarm Test
13.4.4.2.7
2.12
T
Automatic Air Pressure Maintenance Device Test
13.4.4.2.8
2.13
T
Control Valve – Operation
13.3.3
2.14
T
Valve Supervisory Devices
13.3.3.5
2.15
T
Backflow Preventer Assemblies
13.6.2
2.16
T
PRV – Partial Flow
13.5.1.3
* 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 2.3
Sept. 3, 2013

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