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2.' Annual Tests 2. Monthly Maintenance Items Annual pump test was run using the following method:(check one) A. Isolation switch and circuit breaker exercised?&Yes O No G B. Battery case clean.dry and free of corrosion? 0 Yes 0 No O N �ethod A. Discharge of flow through hose streams. C. Batt ' s specific gravity or sta/rin arge p d test? Flow readings taken at each hose stream. ❑ Yes ❑ No 0 N/A O Method B. Discharge through by-pass flow meter to drain or D. Charge and charge rate passed ins tion?O Yes O No 0 N/A suction reservoir. Flow readings taken by flow meter. E. Battery c arge being equalizeds No 0 N/A 0 Method C. Discharge through by-pass flow meter directly F. Circuit b ers cleaned? 0 Yo N/A returned to pump suction. Flow readings taken by flow meter. 3. Quarterly aintenance Items Note: At least once every three years method A or B must be used A. Cleaned stray er,filter or dirt lel fuel system? Pump Test Restilts 0 Yes O No N/A No Flow Rated Flow Peak Flow B. Cleaned or reply ed crank case r in lubrication system? Suction 0 Yes 0 No ❑ /A Pressure C. Cleaned water s er in coolam? O Yes 0 No 0 N/A Disc e / D. Insulation acce tabl and fire heliminated from exhaust Pressure ` system? O Yes O N O N/A Flow N/A E. Battery terminals clean d tighes O No 0 N/A F. Electrical system free o wire ch0 Yes ❑ No O N/A Electric Voltage N/A 4. Semi Annual Maintenan a Items and Current A. Manual starting means on lectrical systems operated? Pump Ck Yes 0 No 0 N/A Speed B. Antifreeze tested in coolant s tem? O Yes 0 No a N/A Are e values in e a ve to a—acceptable? es ❑ o O A C• Flexible exhaust section acc ble? 0 Yes O No ( N/A No-flow(churn)test run for 30 min?�Yes O No ❑ N/A D. Alarms operated on electric 1 pions of diesel engine systems? Circulation relief valve and pressure relief valve operated properly 0 Yes O No A N/A during all flow tests?AYes O No 0 N/A E. Boxes,panels and cabinet on ele rical systems cleaned? No alarm indicators or other visible abnormalities observed during V Yes ❑ No ❑ N/A no flow test? `Yes ❑ No O N/A 5. Annual Maintenance It ms D. Low Suction Throttling Device Test A. Changed pump bearing ubrication? Yes ❑ No til N/A 1. Low suction pressure simulated? 4!f-Yes 0 o O N/A B. Shaft end play accepts le? 0 Yes O No 14 N/A Free from abnormalities in throttling action?�es O No 0 N/A C. Pump coupling align ent acceptable? l� Yes O No ❑ N/A 2. Free from abnormalities in return to full flow$Yes O No❑N/A D. Transmission coupli ,right angle ge drive and mechanical moving E. Automatic Transfer Switch Test parts lubricated? ❑ es O No 9 N/A 1. Power failure simulated during peak flow? 0 Yes O Nq;&N/A E. Circuit breakers pas ed trip test? Q Yes 0 No 0 N/A Connection made to alternate power source? 0 Yes O NqO&N/A F. Emergency manual caning means operat without power? 2. After termination of simulated power failure did motor reconnect 0 Yes 0 No 'N /A to the normal power source? O Yes O No06-N/A G. Electrical con nec ons secure?�R Yes 0 o 0 N/A F. All Alarm Conditions Simulated?A "des ❑ No O N/A H. Pressure switch s tongs calibrated? ❑ Yes No N/A All Alarms Operated',6--Yes O No O N/A I. Motor bearings g eased? 0 Yes 0 No 72 N J. Fuel tank free of ater and foreign material? Yes 0 No M N/A C. Maintenance K. Tank vents and vertlow pipes free of obstruct ns?QYes ONo ON/A A maintenance schedule must be established in accordance with the L. Fuel piping ac ptable? ❑ Yes 0 No 'N N/A manufacturers instructions. /n the absence of such a schedule, the M. Oil and filters changed in diesel systems? ❑ Y s O No �k N/A following must be used: N. Antifreeze ch nged in coolant system? 0 Yes No V N/A 1. Weekly Maintenance Items for Diesel Engine Systems: O. Heater exch ger cleaned out? 0 Yes 0 No ft /A A. Fuel tank level,tank float swi<1e solenoid v ve operation P. Duct work louvers(combustion air)acceptable? Yes 0 No QN/A acceptable? O Yes ❑ No ❑ Q. Exhaust sy em free of back pressure? O Yes O o 11 N/A B. Diesel fuel system free of watYes 0 o Cl N/A R. Exhaust system hangers and supports acceptable? Yes 0 No m N/A C. Flexible hoses and connectorsand lant systems S. Control and power wirings tight? 0 Yes O No Cl /A acceptable? O es O No ❑ D. Oil level and lu oil heater ae? ❑ Yes ❑ No O N/A Part III - Comments (any "no answers,test failure or other E. Coolant level acce C e? 0 No ❑ N/Aproblemsfound with the fire pump must be explained here.) F. Water pump for coolant s ting? 0 Yes O No 0 N/A G. Jacket water heater for coo nacceptable?0 Yes 0 No 0 N/A H. Exhaust system free leakages o O N/A I. Drain condensate tra on exham operas al? O Yes 0 No O N/A J. Electrolyte level in batteries acceptable? O Yes O No ❑ N/A K. Connections to electrical system acceptable? ❑Yes 0 No O N/A Part IV - Inspeetor'�Information I certify that the information on this form is correct at the time and place Vi4w,"., my inspection,and that all equipment tested at this time was left in Inspector: operational condi[' n upon com IFtio of this inspection except as noted Company: in Part III above Company Address: W .S, Signature of Inspector 01992 National Fire Sprinkler Association.P.O.Box 1000,Patterson,NY 12563 7 —( 3 —0 A Form 25-20 Sheet 2 of 2