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Report of Inspection, Testing, and Maintenance of Fire PumpPump ID: Sample Fire PumpBuilding Name: Sample BuildingBuilding Owner: Acme, IncJob Site: 123 Maple Ln5th FloorSafety City, IL 60042Date of Test: 2017-04-01Type of Test: Sample Annual Fire Pump TestTesting Firm: Nolan Fire Pump System Testing2585 Millennium DriveUnit BElgin, IL 60124Testing Firm Noelle MasenContact: noelle@aquariusfp.com847-289-9191
Customer InformationCompany Name: Sample Annual CustomerFull Name: William WatsonPhone Number: 555-555-1234Fax Number: 555-555-5678Email: wwatson@sample.comAddress: 123 Elm StSuite 42Springfield, AK 99542
Fire PumpPump ID:Sample Fire PumpPump Type (check one):HorizontalVertical In-LineVertical TurbineEnd-SuctionManufacturer:Fire Pump IndustriesModel:ABC PumpSerial Number:01-234567Listed (check all that apply):FMULULCRated Capacity (GPM):1250Total Dynamic Head (ft):231Head at Churn 0% (PSI):107Head at Rated 100% (PSI):100Head at Overload 150% (PSI): 87Rated Speed (RPM):1775Pump Rotation:ClockwiseCounterclockwiseSuction From:City MainImpeller Diameter (In):15.7Right Angle GearGear Ratio:0Fire Pump DriverType:Diesel EngineElectric MotorOtherManufacturer:ABC MotorModel:DK123459Serial Number:ABC6789Listed (check all that apply):FMULULCRated HP:125Rated Speed (RPM):1780Frame Size:405TSMotor Enclosure Type:ODPElectric DriverRated Voltage:460Rated Full Load Amps:147Phase:3.0Cycles (Hz):60Service Factor:1.15Fire Pump ControllerType:Across the lineManufacturer:Controller IndustriesModel:FPCC789Serial Number:34526ABC
Listed (check all that apply):FMULULCRated HP:125Phase:3.0Cycles (Hz):60Rated Voltage:480On PSI:135Off PSI:145Type of Start:AutomaticRun Timer Setting (min):10Jockey PumpManufacturer:Jockey IndustriesModel:JP4567Serial Number:12345ABCRated HP:1.5Rated Speed (RPM):3450Rated Flow (GPM):0Rated Pressure (PSI):0Phase:3Cycles (Hz):60Rated Voltage:460Rated Amps:0Jockey Pump ControllerManufacturer:Pump Controller IndustriesModel:JPC1.5Serial Number:56789Rated HP:1.5Phase:3Cycles (Hz):60Rated Voltage:460On PSI:145Off PSI:155Other InformationNotes:This is a sample fire pump. Manufactures, models, and serial numberswere made up.Report generated by Fire Pump Tester Software by Hydro Flow Products, Inc.
Test ResultsDate of Test:Type:2017-04-01Sample Annual Fire Pump TestFire Department Attendee: Inspector John FireBuilding Representative Attendee: Joe FireTesting Firm Attendee: J. NolanFlow Device Used:1 3/4" Nozzle Insert (HM2H)Other Information:The fire pump passed the test. No failures to 120Total FlowFlow1234FlowDevice----% RatedFlow GPM 39486138487138484156486155486155Flow 591867.6100.7149.4
Report of Inspection, Testing, and Maintenance of Fire Pump Pump ID: Sample Fire Pump Building Name: Sample Building Building Owner: Acme, Inc Job Site: 123 Maple Ln 5th Floor Safety City, IL 60042 Date of Test: 2017-04-01 Type of Test: Sample Annual Fire Pump Test Testing Firm: Nolan Fire Pump System Testing 2585 Millennium Drive
