Oxnard Fire Department 360 W. Second Street Oxnard, CA 93030 (805) 385-7722 Fax (805) 385-8009 FIVE YEAR CERTIFICATION REPORT Service and maintenance report for automatic fire extinguishing systems, including fire sprinklers, dry, deluge and pre-action systems, plus on-site fire hydrants, alarm and supervisory equipment attached to those systems. (As per Title 19, Health and Safety Code, NFPA and the Oxnard City Code) Building Occupant Address City Occupant Phone Building Owner Owner Phone Date Testing Agency Address Agency Inspector License # and Type Inspector Phone System Design/Density(s) Head Temp. Orifice Size Explain All No Answers on Last Page 1. General A. Are all systems in service? B. Is the building completely sprinklered and are all areas protected as per NFPA, Fire and Building Codes, and City of Oxnard Fire Department regulations? C. Is required clearance of stock or storage maintained below sprinkler piping/heads? D. In areas protected by a wet system, does the building appear to be properly heated in all areas? E. Have all sprinkler components been checked to ensure that they have not been recalled by the U.S. Consumer Products Safety Commission? (Ie.Omega Sprinkler Heads, certain Star dry type sprinkler heads, etc.) 2. Fire Department Connection A. Are Fire Department Connections in satisfactory condition; (threads, couplings free, caps in place, check valves tight, gaskets in place, and in good condition)? B. Was back-flush of Fire Dept. Connection completed? C. Are all inlets 18 to 48 above grade? D. Are proper identification signs in place? E. Is FDC located and arranged so that hose lines can be readily and conveniently attached without interference from nearby objects? F. Is the red paint in satisfactory condition? FDP#21 Page 1 of 5 G:\Prevention\Forms\FDP#21 OFD Five Year Sprinkler 03/08
3. Control Valves A. Are all sprinkler system main control valves open? B. Are all other valves in the proper position? C. Are all control valves in good condition and locked open and supervised? D. Are all control valves unobstructed and accessible? E. Are identification signs for all control valves and locations provided? (storage rooms, closets) F. City connection valve Tank control valves Pump control valves Sectional control valves System control valves PIV and/or OSY valves Underground gate valves OPEN SECURED SIGNS OPERATED YES NO YES NO YES NO 4. Risers, Gauges, Inspectors Test A. Inspector s Test- Did the local alarm activate within 90 seconds of opening the Inspector s Test Valve on each system Yes No B. Main Drain Test-Test gauge shall be installed at each test gauge opening to determine accuracy of existing gauges, before conducting the main drain test. RISER TEST PIPE ACCURACY OF PRESSURE FLOW PRESSURE LOCAL ALARM NUMBER SIZE EXISTING GAUGE BEFORE PRESSURE AFTER WITHIN 90 SECS. #1 #2 #3 #4 #5 #6 #7 NOTE: A slow return to original static pressure on the gauges may indicate partially closed valves or obstructions in the underground piping. If a 10 lb or greater drop is recorded a problem may exist. C. Are all risers, gauges, and bracing in satisfactory condition? D. Are the correct spare sprinkler heads (temp., type) and wrenches provided in the spare head cabinet adjacent to the riser? 5. Sprinkler Piping A. Are all sprinklers in good condition, not obstructed and free of corrosion or paint? B. Are all sprinklers lees than 50 years old? C. Is the condition of piping, drain valves, hangers and pressure gauges satisfactory? D. Have sprinklers been checked for proper temperature rating? 6. 1 ½ Hose and Related Equipment A. Is all equipment in Class II Standpipe removed? *Note: City of Oxnard does not require any Class II Standpipes. These Standpipes and accessories should be removed when possible. Page 2 of 5
7. Dry, Deluge, Pre-action Systems A. Were all system components inspected for condition and serviceability? B. Is air pressure and priming water level normal? C. Was air compressor tested to insure good working order? D. Were low points drained during fall and winter inspections? E. Were all quick opening devices tested? F. Have dry valves been trip tested satisfactorily as required (annually)? G. Are dry valves adequately protected from freezing? H. Are valve enclosures and heater conditions satisfactory? I. Were initiating devices tested? (Heat Det./Smoke Det.) 8. On-Site Fire Hydrants A. Have all hydrant stems, threads and caps been inspected for damage? B. Were all outlets on each hydrant fully opened and closed to insure smooth operation? C. Was the hydrant shut-off valve closed and fully reopened to insure adequate water flow? D. Are all hydrants easily accessible and are the outlets 14 to 24 above grade? E. Are all necessary crash posts in place? F. Are all hydrants/posts painted Traffic Signal Yellow? G. This department requires a flow test during this inspection. Provide the GPM and PSI available from the most remote fire hydrant. PSI GPM 9. Alarm and Supervisory Equipment: * Note: All new and updated systems shall be supervised by a listed and approved service as per Oxnard City Code A. Name of Monitoring Company Phone: Account #: Time Notified B. Have all alarm and supervisory equipment (tampers, flow switches, etc.) been tested)? C. Did all supervisory equipment operate as designed during the test? D. Record all alarm times, location (riser #1, PIV, system #1, etc.) and type of equipment (tamper, flow switch, bell, etc.) during each test or service. EQUIPMENT LOCATION EQUIPMENT TYPE TIME OF EACH ALARM TEST TIME ALARM COMPANY RECORDED RECEIVING EACH ALARM TEST * Note: Repair and retest: if defects are found in equipment tested, correction of such defects shall commence IMMEDIATELY** and shall be completed as soon as possible, but in every case within 30 days of initial test. At the completion of repair, the system or device shall be retested as necessary to determine that it is fully operable. Page 3 of 5
10. PROVIDE OVERALL SYSTEM DESCRIPTION Page 4 of 5
Explain All No Answers The City of Oxnard requires a PERMIT for any alteration to an existing system. Contractors may contact Development Services for more information, forms or pricing. The City of Oxnard Fire Prevention Bureau requires notification anytime a fire protection system is not operable Service Label: A service label conforming to Title 19, section 906, shall be securely attached to a system only after all deficiencies have been corrected as per Title 19, Section 904.2.d. A copy of this report is to be mailed or faxed, (805) 385-8009, to the City of Oxnard Fire Department Prevention Office within 7 days of the first service/test and again after all required retesting/repairs and certification. A copy of this report shall remain available for inspection on premises. I hereby certify that the fire protection equipment indicated in this report has been tested in accordance with the State of California Health and Safety Code, Title 19, State Fire Marshals Office, and the Oxnard Fire Department. The system is in proper operating condition with service label affixed System Failed Signature Date