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n Grinnell° <br /> `"^��'' FIRE PROTECTION SYSTEMS COMPANY <br /> • INSPECTION CONTRACT <br /> ����� N0.�C�.,-.:.�".7..`.�.c, tf.?. " <br /> INSPEG'�ON�i�RT <br /> No. _...... .. _. _ REPORT OF INSPECTION BUREAU FILE _ ............. '� <br /> N0. ........__..... .............. r <br /> SET 2 OF 2 <br /> i. DRY SYSTEMS ' Yes N.A.� No' <br /> a. No.of systems�Make& odel '= � <br /> Date last trip tested ` �' " <br /> - b. Is the air pressure and priming water levels normalt <br /> c. Did the air compressor operate satisfactorilyt <br /> k d. Were all low points drained during this inspeaion� <br /> e. Did all quick opening devices operate saFisfactorilyt ` <br /> f. Did all the dry valves operate satisfadorily during this i�spedion� L-'' <br /> g. Do dry valves appear to be protected from freezing� - <br /> h. Is the dry valve house heaied� <br /> 7. SrEC1AL SYSTEMS � <br /> a. No.of systems�Make&Model <br /> Type <br /> b. Were valves tested as requiredt <br /> c. Did all heat responsive systems operate satisfactorilyt <br /> d. Uid the supervisory features operote during testingt <br /> Heat Re;ponsive Deyices: Type Type of test- <br /> Valve No. 1...... 2...... 3......4...... 5......6...... Valve No. 1...... 2...... 3......4......5......6...... !; <br /> Valve No. 1...... 2...... 3......4...... 5......6...... Valve No. 1...... 2...... 3......1...... 5......6...... <br /> Valve No. 1...... 2......3......1...... 5......6...... Valve No. 1...... 2......3......4......5......6...... <br /> Valve No. 1...... 2...... 3......4...... 5......6...... Valve No. 1...... 2...... 3......4...... 5......6....... <br /> Auxiliary equipment: No. Type <br /> Location <br /> Test results <br />- _ L ALARMS Yes N.A.; No• <br /> a. Did the warer motors and gong operate during testing� = <br /> b. Did the eledric alarms operate during testingt <br /> c. Did the supervisory alarms operate during testingt <br /> ^ !. SrRINKLERS—rIMNG <br /> a. Do sprinklers generally appear to be in good external conditiont <br /> b. Do sprinklers generally appear to be free of corrosion,paint,or loading and visible obstructions� <br /> c. Are extra sprinklers available on the premisest ✓�_ <br /> d. Does the exterior condition of piping,drain valves,check valves,hangers,pressure gauges,open sprinklers <br />' and strainers appear to be satisfactoryt <br /> e. Ooes the hand hose on the sprinkler system appear to be in satisfactory conditiont <br /> 10. EXrI.ANATION OF"NO^A[VSWERS(Fw Sections 1S thru 9): <br /> -�l; ,d/c1 f; : t . � .^ �/f�D'� <br /> 1J..THE INS/KTOR SUGGE.ST$TFiE FOLLOWING NECESS RY PROVEMENTS.HOWEVE THESE SU�GESTIONS ARF NOT THE RESULT OF AN ENGINEERING SURVEY: <br /> �_�� .�.��1.���_L �rf r��, �",�;y �-./�� �� !(� S` �� � ��i.�r�, r�l�'�� �i r��t� <br /> 12 ADJI�ISTMENTS O�t CORRECTIONS MADE: f` <br /> •! { :r�;�l/ �..�..�17 �/1 i i� ��/1 f SS[ .�� !•` �— <br /> r / ��� J� <br /> 13. UST CHANGES IN THE OCCU�ANCY HAURD OR FIRE PROTECTION EQUI►MENT,AS ADVISED SY THE OWNER IN SECTION 1A: <br />�': <br /> �'� ,.� _ <br /> 14. INSrECT10N AND SUGGESTED IMPROVEMENTS WEIt�DISCU656D WITH THE UNDEitSIGNED OWNER flR OWNER'S RE►RESENTATIVE-I�7 <br /> � < , ��_"� / <br /> Signature of owner or owner's representative ,LS,:�,� �„Z�-_�%�-��/ Date <br /> DUPLICATE TO: <br /> STREET <br /> CITY d�STATE ZIP <br /> ATT. <br /> G4550-2 tNot Applicable <br /> •Explain(No)Answers on Back o(Sheet <br /> 9NSURANCE BURE�1l1 COPY <br />