Fillable Printable Automatic Sprinkler & Standpipe Equipments Inspections & Tests

Automatic Sprinkler & Standpipe Equipments Inspections & Tests

REMARKS (Use reverse side if necessary)

INSPECTOR

SHEET NO.

LOCATION

INSTALLATION

WATER SUPPLIES

DATE

AUTOMATIC SPRINKLER & STANDPIPE EQUIPMENTS INSPECTIONS & TESTS

For use of this form, see TM 5-695; the proponent agency in The Chief of Engineers.

PRESSURE

QUICK OPEN-

ING DEVICE

PRESSURE

OUTSIDE

SOURCE

GRAVITY

TANKS

PRESSURE

LBS. / SQ. INCH

LEVEL

FEET

FIRE

PUMP

PERFORM-

ANCE

DRY PIPE VALVES

MAIN DRAIN

VALVE

ALARMS STANDPIPES CONDITION

RESERVOIRS

(1) (2) (3) (4)

(5) (6) (7) (8)

(9) (10) (11) (12) (13)

DA FORM 4005, JAN 1973

REPLACES DA FORM 5-119, 1 APR 47, WHICH WILL BE USED.

APD LC v1.00

BUILDING NO.

SYSTEM NO.

P.I.V. & OTHER MAIN

CONTROL VALVES

ALARM CHECK

VALVES (Pressure)

FIRE DEPT.

CONNECTIONS

WATER

AIR

PRESSURE

VALVE

NORMAL

RESIDUAL

LOCAL

CENTRAL

PRESSURE

HOSE

HOSE VALVES

NOZZLES

CHECK VALVES

SPRINKLERS

PIPING

HANGERS