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2. Anna Fire Department
   305 S. Powell Parkway
   Anna, TX 75409
4. A pre-test of any system regulated by the Fire Department and that requires acceptance testing or inspection shall be performed without failure. Once the pre-test has been performed, this certification form shall be submitted to the Anna Fire Department prior to the scheduling of any inspections for the regulated system.
   *Note: The Fire Department does not perform partial inspections. Inspections shall be scheduled at least 48 hours in advance.
8. Please check one:*

   1. New Inspection
   2. Re-Inspection
10. Contractor Name*
11. Contact Person*
13. Phone Number*
    A fire inspector will contact the person above to schedule the requested inspection.
14. Email Address*
18. Failure to appear for a scheduled inspection will result in automatic fines.
20. Permit No.*
21. Project Name*
23. Project Address/Location*
25. Type of Test*

    1. Underground Fire Main (Hydro/Visual/Flush)
    2. Remote FDC (Hydro/Visual/Flush)
    3. Fire Sprinkler Overhead (Hydro/Visual)
    4. Clean Agent System (FM 200)
    5. Fire Pump
    6. Standpipe (Hydro/Visual/Flush)
    7. Fire Alarm System
    8. Access Control System
    9. Commercial Cooking Hood Suppression
    10. Flammable/Combustible Liquids
    11. Fuel Dispensing System (Primary/Secondary)
    12. Fire Dept. Gate Access
    13. Emergency Power Generator
    14. Fire Insulation (13R or 13D)
    15. Other
26. Date of Pre-Test*
28. If other please describe:
32. By signing this or providing an electronic signature, I attest that a pre-test has been performed at the above location for the above-named system type. I have found no failures to the system and I further attest that the system will be ready to test at the scheduled time with the Fire Department. I am aware that if the system is not ready to test/inspect, any deficiencies are found, or if any failures occur during the test an acceptance failure will result. If a failure is assigned, a new pre-test shall be performed and a new inspection scheduled after appropriate re-inspection fees are paid.
    *

    1. I agree
34. Contractor Signature*
35. Date*
    Date
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field