Affiliate Partner: Marmic Fire & Safety
Instructions
1. Schedule visit with store manager. Identify yourself as an affiliate partner of
Commercial Fire. Record the name and title of the manager with whom you made the
appointment and the date and time of the appointment:
Name _______________ Title __________ Date __/__/__ Time __:__ am pm
2. Check in upon your arrival at the store. Call Commercial Fire IVR using the phone
and tracking number above. If there are any issues using IVR, call Commercial Fire at
800-241-1277.
The customer requires successful IVR call-in and call-out per the instructions
provided. is an essential part of this work order. IVR must be successfully completed
for this work order to be complete. Failure to successfully IVR will result in a 10%
penalty on the entire amount of the invoice for this work!
3. Scope Of Work:
Perform annual NFPA 25 inspection of hydrant(s). A complete inspection form must
be filled out detailing all aspects of hydrant inspection and returned with signed work
order and invoice.
4. Additional Work If you find additional work that can be repaired on site, call the
IVR phone number and hit option 2 to request authorization. If work is authorized,
record the work authorized and the authorization number in the adjacent space.
5. Complete survey forms in their entirety. You must complete the Technician
Statement and indicate whether any additional work remains. You must have
signature on the Work Order.
6. Check out before departing from the store. Call Commercial Fire IVR using the
phone and tracking number above. Enter the Closing Check Out number:
____________________.
Service Location:
Tractor Supply #1452
1570 E State Route 15
Belleville, IL 62221
US
Phone: (618) 355-9512
Work Authorized:
Private
Hydrant
4571344
Additional Work Authorization Number
Store Stamp
_________________________________
Customer Signature
_________________________________
Print Name
___________________ ___ / ___ / ____
Title Date
(use separate sheet if necessary)
Start Date: 8/1/21
Deadline: 8/31/21
IVR Phone: 844-325-8006
Tracking No: 182505683
Customer PO: 700000126
Commercial Fire, LLC
2465 St. Johns Bluff Road S, Jacksonville, FL 32246
800-241-1277 Fax 800-956-9789
Important Reminder:
CommercialFire Mobile App
is the preferred and fastest
method for check in/out
compliance!
Visit CommercialFire.com/CFConnect for
more information
Wo002 06/23/2017
Job 22327088
Mod
Kevin Sisk
8/5/21
Mod
If the answer above is yes, describe every deficiency, detailing with particulars how this system is deficient. Separately
inspecting affiliate will provide Commercial Fire Inc. with a quotation (see below) for the cost to repair these deficiencies.
All deficiencies REQUIRE Photos
Description of all deficiencies
Please provide a complete price quote for the repair of these deficiencies, detailing the scope of work, the parts and materials
required and their cost, the number of men required, the number of hours of labor and the cost per hour to perform the repair
and all other charges. Quote must be broken down by Scope of work, Materials required, Cost of materials, Number
of hours (1 or 2 men) and Cost of labor, otherwise Commercial Fire will be unable to process quote for approval. Please
use the accompanying form.
Indicate whether any deficiency has been found at this location during the course of performing this work order, #4571344, by
circling yes if deficiencies were found or no if deficiencies were not found. If deficiencies were found, describe them below,
detailing with particulars how the system is deficient.
System has deficiencies: YES NO (circle one)
Name: ______________________ Signature: ______________________________ Date: ________, __ 20___
4571344
Technician
Statement
Service Location:
Tractor Supply #1452
1570 E State Route 15
Belleville, IL 62221
US
Inspecting Affiliate:
Marmic Fire & Safety
11694 Lackland Rd
Saint Louis, MO 63146
Wo002 06/23/2017
Kevin Hergenroeder
8/5/21
Inspecting Affiliate:
Marmic Fire & Safety
11694 Lackland Rd
Saint Louis, MO 63146
Service Location:
Tractor Supply #1452
1570 E State Route 15
Belleville, IL 62221
US
Private Hydrant Inspection Information
Wo5104 8/13/2104
6. How many total gallons flowed during test: __________ gal
If not please be specific:_______________________
__________________________________________________________________________________________________
5. Was a 60+ second full flow test performed?
7. What is the Static pressure? _______ psi
Other comments (list deficiencies on deficiency page):_____________________________________________________
1. What type of hydrant is this?
Dry Barrel (mark one)
Wet Barrel
2. Who is the manufacturer of this hydrant? ___________________________
3. What is the model number of this hydrant? ___________________________
4. What size is the hydrant?
5 1/4
4 1/2
Yes No (mark one)
8. What is the Residual pressure? _______ psi
9. What is the Pitot pressure? _______ psi
10. What is estimated GPM flow? _______ gpm
11. What is the Size of outlets flowed? _______
12. What is the Number of outlets flowed? _______
14. What is the type of thread?
NPT (mark one)
NST
13. Is the Fire Hydrant accessible?
Yes No (mark one)
16. Are the threads lubricated?
Yes No (mark one)
17. Are the threads in good condition?
Yes No (mark one)
__________________________________________________________________________________________________
15. Is the hydrant open left or open right?
Left Right (mark one)
18. Is a wrench available?
Yes No (mark one)
Asset Data
4571344
Mueller
2400
120
90
24
850
2 1/2"
1