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3/03
Inspection Contract#
Date:
Inspection Frequency:
Monthly
Quarterly
Annually
Other
N/A
A.4.2
A.4.3
A.4.4
psi
psi
sec
DATE _______________
REV. 3/03
Report of Inspection, Testing & Maintenance of Fire Pump Assembliescontinued
Inspecting Firm:
Inspection Contract#
Date:
Inspection Frequency:
Monthly
Quarterly
Annually
Other
psi
psi
sec
N/A
F.3.1
F.4.0
F.4.1
F.4.2
F.4.3
F.4.4
F.5.0
DATE _______________
psi
psi
sec
REV. 3/03
Report of Inspection, Testing & Maintenance of Fire Pump Assembliescontinued
Inspecting Firm:
Inspection Contract#
Date:
Monthly
Quarterly
Annually
Other
psi
psi
sec
psi
psi
sec
N/A
DATE _______________
REV. 3/03
Report of Inspection, Testing & Maintenance of Fire Pump Assembliescontinued
Inspecting Firm:
Inspection Contract#
Date:
Monthly
Quarterly
Annually
Other
N/A
psi
psi
psi
H.4.5
H.4.6
H.4.7
H.5.0
psi
H.6.0
H.7.0
H.8.0
H.9.0
H.10.0
DATE _______________
REV. 3/03
Report of Inspection, Testing & Maintenance of Fire Pump Assembliescontinued
Inspecting Firm:
Inspection Contract#
Date:
Monthly
Quarterly
Annually
Other
sec.
sec.
sec
sec
Oil Pressure:
psi
Speed indicator:
rpm
Water temperature:
Oil Temperature:
PUMP:
Make
Type
Rated Capacity
Rated Pressure
Rated RPM
Date of last annual flow test:
CONTROLLER:
Make/Model
Listed
COMMENTS:
Suction
Pressure
(PSI)
Discharge
Pressure
(PSI)
Net Pump
Pressure
(PSI)
Pump
Speed
(RPM)
Lead #1
Lead #2
Lead #3
Pitot
Pressure
Dia. of
Nozzle
Openings
No. of
Nozzles
Flowed
Flow
Based on
Pitot Pres.
Opening
Coefficient
C= _____
Amps
Lead #1
Lead #2
Lead #3
Actual Flow
(GPM)
Churn
100%
150%
Volts
Churn
100%
150%
Notes:
Remarks on Test
Date of Examination
DATE _______________
City/State/Zip
Address:
Property Name:
Cont.No.
Date:
Time:
Churn
100%
150%
Churn
100%
150%
FLOW
POINTS
Volts
Lead#1
Lead #2
Lead #3
Pump
Speed
(RPM)
Amps
Dia. of
Nozzle
Openings
Lead #1
Lead #2
Lead #3
No. of
Flow
Opening
Nozzles Based on Coefficient
Flowed Pitot Press. C= ____
Actual
Flow
(GPM)
REV. 3/03
Report of Inspection, Testing & Maintenance of Fire Pump Assembliescontinued
DATE _______________