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HomeMy WebLinkAbout3200 BUCK OWENS BOULEVARD:AND ~~rrH L~;as amenaed b; :;:CCR,;.-Titte ;7:9 Property Ir~fo[mation: . . Name: ~ ,Q~/~~ Occu anc /Use: ;~_ p . y ~ .Address; ~ ~ Construction Type: C~' No. Stories: ~P' Year Co.nstrueted: Contact: Telephone: .llq _ 7 4 r--- ,~._ . . tor information: Jor.g_.e. nsen Company ~ 2691 S. East Ave ~39(, °...W~. Fres~no CA 93706 559- 2fi:8- 624'1 ~ 2629;95 ~ # (P~int) Fonns includ.e.d,wtth this report ,I~Automatic Sprinkie~ System O Standpipe and Hose Systems O Private Water Supply System ~ Fire Pump 0 Wafer Storage Tank ~ ^ Water Spray System O Foam •Water Sprinkler System .~Number of System Risers Copy sent to: o Owner Date l~fFireAHJ Date f-ZZ dg o Contractor Date ..,. . ~..~. 1) For spec,ific inspection, testing, and maintenance req,uinements and infoRnati_on, see N~PA 25, Z002~Edition as amentled b.y California Co.de of Regulations, Title 19„§901 to §906. 2) .Inspectio;n. fteims may be perfoRn:ed. by~ the O.wner in accor+dance with Califomia:Code of Regulations Title 1.9 ~9,04.1(a) ~oter ~ Num6er of Forms ~ N/A ~ FAIL* ~ PASS 5 ~ / 6 ~ ~ ,7 8 ,.~r 9 ~ . ]0 11 . State Fire Marshal AES 1 . • March 21,.2006 ANNEX B 25-79 Inena..H.. _t~~ae_ ----~---•-•., •~~~•~a,~a~~u mn~r~~nance NFPA 3S ,Cha ter 5 as am~ehdei rire SprlnKle~ System Page 1 of 4 !- b C"CR, Title 19 Date of Inspeotion,~Testing, Maintenance: ~ i~. l~ / System Riser ID: ~_ Property Infocmation: Name: ~/ZN/~2~ Type of Sysfem: o~ ~~ti ~ ~~ , o ~B( Wet Pipe ~ ~ ~ Address: ~ ~d ~vC .:~CSG~~~ , ^ Dry Pipe N . ~. 0 Prea~ction u~ -r t :,: '' . - 0 Detuge 9~ ~ i p~ ~~Y ~a ~~ ~'~~ "!~~~2 ~.,~ - - Ma111 Dral~ Test Results: Abbreviation Key; I = Inspection Initial Static Pressure: /~0 ps ( ~) T= Test //Q M = Maintenance Residual Pressure: i (ps ) A 0.= Aft~r Operation /s- 7 MI = Rer Manufacturer's Instwctions Restored $tatic Pressure: G~ ~~~~_ Item Activity Frequency . Descriptiqn ' NFPA 25 Fail N/A Pass ~ Reference 1,1 ~ Daily PreactioNDeluge<Valves-Enclosure Weski tem . rature 'I2.4.3.1~ ~ 2 ~ Daily Dry Pipe Vafves - EnGiosure Weekl tem er;~ture 12_4.d:~.1 1.3 I ~uarterly . Gauges (Dry; Freaction, Deluge 5.2.4.2 S stems 5.2.4.3 1•4 I Duarterly Control Valves ' 12.3.2.1 1.5 I~ Quarterly Alarm Devices 52:6 ~•s ~ Quarterly Gaug,es (Wet Ripe Systems) 5.2.4.1 1.7 I Quarterly Hydraulic nameplate . g,2,7 1.8 I Quarterly Pfpe and Fittings 5.2.2 1.9 I. Quarterly Sprinkiers 5.2.'I 1•10 I Cluarteriy SPare Sprinklers 5.2.~.3 1•11 ~ 1 Quarteriy FireDepartmentConnections 12,7,1 1.12 I Quarterly Alarm Valves - Exterior lns.pec~tlon 12,4,1,1 x 1.13 1 Quarterl y PreactioND.e(uge Valves .- Exterior 12 4 3 1 6 Ins edion . . . . ~•~4 ~ Gluarterly Pressuie Reducing Valves . 12.5.~.1 ~•~.5 ~ Gluarterly . Dry Pipe Vaives - Exterior Inspectiori ~12~4.4.1.4 x ~•~s ~ Qua~terly Backtlow Preventers 12_6..1 1.17 I Annually Buildirigs 5.2.5 State Flre MarShal AES 2 ~ March 21; ;2006 25-80 OF WATER-BA~ED FIRE pROTECTION S Date of lnspection, Testing, Malntenance: _~_ i~-~ Property Information: ~ Name: __~121U )D~' ~i?`~~ Addroes: ~~~ U ~~ ~ _ ~'~ ~.S ~'~~ 4 F+/E~lJ ~ Item Activity Frequency ~ . Descciptfon. 1..18 I Annually Hanyers 1.19 i Annuaily SeiarNc B[apea 1.20 1 5 Yeara ' Hanyeta (Acceasible con , 1.21 I 5~Years Setamic Braoes (Accessible. s ces 1.22 I 5 Years ~Pe and Fit6-;~gs (Aocessibl .s ces 1.23 ~ I 5 Years Sprinlde~s (Acoesside co 1.24 I 5 Years Alarm Valves-Intedorlhs ~•ZS ~ 5 Years Alarm Valves -$trainers, flite 1.26 I SYears ChedcValves.-lnterior,i.ns 1.27 I SYears ~~o~~Vafves-~ Ine cfion 1.28 I 5 Years Preaction/Deluge Valves - ffftera orificea ' 1 ~:>~CR, Title 19 . System Riser iD: _~ Type of System: Wet Pipe ~ ~ Dry, Pipe O PreaeEion O Deluge Page Z of A 25 ~ Fail N/A .: .Pass ~ence 5.2.3 5.2:3 led spaoes) 5.2.3.3 concealed 5.2.3.3 ;concealed . 5.2.2.3 al~d spaCes) 5:2.1.1.4 ctlon. 12.4.1.2 rs, odfices 12.4:1.2 etion 12_4.2.1 ferior 12.4.3.1.7 rainers, cea e rx;e pe pe n St 12.4.3.1.8 •29 1 30 ~ 5 Years Dry Pipe Valves -('ntetior Inspec~on 12.4.4.1.5 . 2 1 I S Years C1ry Pipe VaNes . StraineB; tflters, .orifices 124.4.1.6 . T Annuaily AlarmDevioes;(gagec) 5.3.3 12.2.7 2.2 2 3 T T Annually Ma(n Dra(n.Tesf.(Enterd&taon?ege 1) ' : 12.2:8 12,2,g,~ 12.3.3.4 . 2 4 T Annually Antifre~e Test 5.3.4 . 2.5 z s T T Annually Annually Contrd Valve - Posibon • Corrtcd Valve.-Qperation 12.3.3.1 12.3.3.1 - 2 7 Annually Supervisory • • . . 12.3.3.5 . 2 8 T Annually Pre~ciion Valve ~- F~imin Water , 9 . "12.4.3.2.1 . 2•9 T T Annually Annually Pr~dion Vaive-l,.owqir.FressureAlarm ~Preac~on Valve - Fuil Flow Trip Tesf ' 12.4.3.2.10 12.~4,3;2,2 State Fire Marshaf AES 2 ~ March 21, 2006 ANNEX B 25-81 Inspectto~~ Teating, and Malntenance ~lre,SprinkierSystem NFPA 25 Cha fier 5 as,am~,e~¢ed~ b CCR~ Title 19 P~9e 3 of 4 Date of Ins}~c6on, Testing, Mai~enance: / ~~ ~ q ~N_,~.L ;. S~#em Riser ID: -~i Property Inforr~ation:. .. . Name: ~_~~' ~~ /~ddress: 3Zap ~jf~p(1~~'J~ City. Item 2.10 2.1 ~ 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2..19 2.20 2.21 2.22 2.23 2.24 2.25 3.1 3.2 3.3 3.~ 3.5 - ------ 0 ~~.~ ~ LZ'~,,~ A~~Y Frequency . Descriptlon T Annuaily D Pi V Type of System: ~We~t Plpe ~ Dry Pipe ^ Preaction ~ ^ Deluge ry pe alve - Primin~ Water 12.4.4.2.1 T Annually ~~Y Pipe~Value -- Low.A(r Pressuce Alarm . . 12.4.4.2.6 T Annualty . ~~Y Pipe.Valve - Quick-0pening DevJce 124.4.2.4 T ' MnuallY Dry t?iPe Valve - Trip Test 12.4.4.2.2 T Annually BackflowPreventerAssemblie$ ~2,g,2 T 3 Years bry Pipe Vatve - FuIl.~low~Trip Test 12.4.4.2.2.2 T 5 Years Gauges 5.3.2 T 5 Years Pressu.re Reducing Valve ~2.5.1.2 T ~ Yeers Fire Department Connec~on 8ackflush ~2,7,4 ' T 5 Yeara Sprinlders - Eztra,High:Tempetature 5.3.1.1.1.3 T 5 Yeara ' Sp~nklet~a'- Cor~~e:emrironment or cocrosive=water 5.3.1.1.2 T 10 Years. Sprinklers._ Dry . 5.3.1.1.1.5 T ' 201 ears Sprinklera.- Fast Responae 5.3.1.1.1.2 T 50Years Sprinklers 5.3.1.~.~ T 75 Years Sprinklers 75 y~ars:in aervice 5.3.1.1,1.4 T Sprinklera:manufacture~ prior to 1920 - Re ace • 5.3.1.1.1.1 M Annually CoMroi V.alves • 12.3:4 1 N Annually PreactioNDel:uge Valves 12.4.3.3.2 M . Annuaily ~ ~~Y P~Fe 1Faives/Qt~ick-Qpening Devices ~ 12.4.4.3.2 M Annually Dry Pfpe •Valve - Low. Pd~ Drains '12.4.4.3.3 M 5 Years Obgtruction Investi9ation Cha er 13 p# Fail N/A Pass State Fire Marshal AES 2 ' I ~ Mareh ~21, ~2006 j ~ . • 25-82 INSPECTION, TESTIIIG AND _ I . MAINTENANCE OF W~TER BASED F1RE PROTECTION SYSTE1vIS' Inspection; Testing~ and Mairitenance;Fire S.prinkler System Rage 4,.of 4 NFPA 25 Cha tet 5 aa,;amend~d b J C.CR, Tit.I.e:19 . C~ate of Inspedion, Testing~ Maintenance: - - System Riser ID: _~ Property Information: Name: Type of System: ,PT Wet Ripe Address: ~J~ Q ~ ~ 'bry Pipe ^ Preaction ~ Deluge City. ~ ~_ Deficiencies, and Gomments: Item D~flctencies.and Gommenta,item number.muatoorceapond to the.l.tem numb~r ~ of the Activi Iisted above: _, ^ See Continuation Page(s) (Indieate the number of continuation pages) , ~PASS ~S~~~~ . ~ uj "" ~ O FAIL a, . S natwre Date State Fire Marshal AES 2 March 21, 2006 . ... ProPertY ~RformaUon: . ~ Name: ° ~ . ~''~~ ~~~~'L- ~° '~ ~ Occupancy%Use: ~ .Address: .~~. Ul~ C.onstruetiora.TYRe; a~ C~. ~ No. Stories: ZIP. ~$ Year Coiistructeii: Contact: ~-~ Telephone: Cc.~/~ _ '7~.p ~~ ,~ r ~ tor Informatian: Jor.gens,en Company ~ 2691 S. ~ast Ave Fres~no - ~ CA 93;7Q6 ~ , ,.,., ....- .. 539- 26:8- 624~ ~ Z62-995 ~~s-~~ ~ 3 Job # (P~in~ Forms tnc.luded w~th th(s report '~Automatic Sprinkle~ System O Standpipe and Mqse Systems ~ O Private Water Supply System 0 Fire Pump ^ Water Storage Tank ~ ^ Water Spray System ~ O Foam ~Water Sprinkler System _.~Number of System Risers Copy sent to: o Owner Date ~ ~ire AHJ Date / ~~ ~ ~- a j, . o Contrac[or Date ~ ~ 1) forspectfic inspection, testing, and ~ maintenance req,uinements and: infomta~ion, see NFPA 25, 2002-Edition as arnendetl by Califomia Code of Regulations,'Title 19~ §:9,01 to .§906. 2) .inspection, (tems may be pecform~tl :by~ the. Owner in accorci~nce with Cailifomia:~Code.of . De~.:.l..~t....~ Tu~_ ... ..~~' ' • • 11 Number of Focros N/A FAIL' PASS ~ X form. State Fire Marshal AES 1 ~ ' March 21 „2006 ANNEx B 25-79 ~ tna~pecttan T ti , es ,ng,~and Maintena~ce Ftre S.prihkler System NFPA 25 :=Cha ter 5 a amend ii b CC T t Page 1 of 4 $ e : R~ i le 19 Date of tnspection,~Testing; Maic~tenahce: ~'~Z-yf ' System Riser ID: ~ Property Information: Name: ~- ~1(~ i~"J ('~ C~~~ TYpe of System: ~~oF cAr~,c ~Wet Pipe ~~ O ; 9 Adclress: 3Zc;t~• ~Uc~ C~..~ ,~i,~ y~~~ ^ DryPipe °ry. ~ ~ ^ Prea~ction ~ ~ - ^ Deluge ~ ~ City. ~~~FS ~{-;~_,~ ~RE~ Ma IVEain Drain Test ResulCs: Abbreviation Key: I = Inspectlon Initiai Static Pressuce: ~~~~ (psi) T= Test Residual Pressure: ' M = Maintenance `f O (psi) A-0.= Aft~r Operation `~~ M1 = Per Manufacturers Instructions Restored $tatic Pressure: ~ i ~ ~. Item Activity Frequency . Description NFPA 25 Fail N/A Pass ~ ~ Refecence -; ~ ~ ~ Daily PreactioNDeluge Valves - Enclosure Weekl tem ratuce . 12.4.3.'1~ . ~ ~ 2 ~ Daily D.ry Pipe Vaiveg - Enctosure Weekl tem er~ture ~2.4.d:1.1 . 1.3 I ~uarterly Gauges (Dry; Preaction,.Deluge 5.2.4.2 S stems 5.2.4.3 ~ 1.4 I Quarterly Controi Valves ' 12.3.2.1 ~. 1.5 I• Quarterly ~ Atafm Devices 5.2:6 ~- 1.6 I Quarterly Gauges (Wet Fipe Sys~ems) 5.2.4.1 ~•~ ~ Quarterly Hydraulic nameplate , 5,2.7 ~, ~ 1•8 ~ Quarterly P(pe and Fittings 5,2_2 ~ 1.9 I. Quarterly Sprinklers 5.2.~ ~ 1.10 I Quarterly Spare Sprinklers 5.2.1.3 ~. ~•~~ ~ ~ ~uarterly Fire Department Connections 12,7,1 ~ 1.12 I Quarteriy Alarm Valves - Extecior Inspectlon 12.4.1.1 ~: ~,13 ~ Q~a~~~y PreacfioNDelugeValrres-Exterior Ins eciion 12.4.3.1.6 x 1•14 ~ Quarterly Pressure Reducing Valves . 12.5.1.1 ~ 1•1.5 ~ Gluarterly . Dry Pipe Valves - Ezterior Inspection' ~12.4.4.1.4 .~ 1 1 . 6 I puarterly Backfiaw Preventers ~ 12_6..1 V ._ 1 17 j : l . . Annuaily Buildings 5.2.5 ~r State Fire Marshai AES 2 ~ . March 21; ,2006 ~ 25'89 ~ INSPECTION, TESTING, AND MAIIVTErJqTJ~E OF WA~_gA~ED FIRE PROTECTTON SYSTE ~yrrs~-L~ 411~ t@~ 58s`:8117@11d. '' ''•••~•~~ rage Z;of 4 . eS1 b ~CR Tftle 1.9 . Date of Inspectlon, Tes~ng, Maintenance: ~Z '~ ~ System .Riser ID: ~ P rQPerty Information: ~ Name: ~ ) ~/1 i -~-J ~~ • c ~ ~.~ . Type of System: ~~ y ~ Addreea: ~2G~ G(~ ~ ^--- ~ ~~v~ Wet Pipe Dry Pipe ^ ` Preaetion ^ Deluge ~~~ . ~~~c~~~- ~~ ~ Item Activfty Frequency ~ Description. NFF''A 1.:18 I Mnualry H~~B Referei 1.19 i AnnusllY SeiarNc,Brapes 5.2.3 ~ .20 I 5 Yeara ~ ~ }{a n~ers (Accessible conc:eaied apeCea) 5.2:3 5 1.21 I S~Years S~mic Bracea (qocessibfe concealed .2.3.3 s ces 5.2,3.3 1.22 I 5 Yeara g Pe;and Fittfngs,Gqo~BS-ble~.conceelec7 123 ~ I 5.22.3 5 Years SprinMe~s (Accessible.oonceatsd s ,P~) 5.2.1.1 4 1.24 I SYears AlarmVaives-ir~teriorihspeedon. . 12.4.~ 2 1.25 I 5 Years Alarm Valves - Strainers, fllters, orifices . 12.4:1 2 1.26 I 5 Years Chedc.Valyes-interioel~ P~on . 12.4.2.1 1.27 I SYears ~'eectiorVDglugeVa(ves-lnEerior ~ ~ne .ction 12.4.3.1.7 1:28 I S Years PreaetiorVDeluge Values -.Slrainers, lfitera .orifices ~ 12.4.3.1.8 1.29 I 5 Years Dry Pipe Valv~ -('ntettor Inspectlon 12.4.4 1 5 1.30 I 5 Years Dry Pipe.Vahres - Strainers; fifters, orifices . . 124_4.1.6 2.1 T Mnually Alarm Deyices;(90 Sec) 5.3.3 122.7 2.2 T Annually Main Drain Test (Entecdata on Fage 1) 12.2.6.1 2.3 T MnuallY ' : Anbfreeze Test 12.3.3.4 2.4 T AnnuallY Contrd Valva - Positipn ~ • 5.3.4 . 12.3.3.1 2 5 T Mnually Corrtrd Valve.-Opera6on 12.3.3 1 2.6~ T AnnuallY Supervisory . . . 12.3.3 5 2:7 T Annually Pre~ction Valve=Ftimin Water 9 . . '12.4.3.2 1 2.8 T Annually Pre~ac~fon Valve- L~wAir Pre su e'Al , 2 9 T . s r arm 12.4.3.2.10 • Annuaily Preaction Val~,e - Fu11 Flaw Tdp'1'est 12.~4.3.2.2 State Fire Marshal AES 2 Fail ~ .N/A ~..Pass X X x March 21, 2006 A~JNEX B 25-81 . inapectton, Testing~ and Malntenance Fire SprinklerSystern NFPA 25 ,~ha ter ~ a~ ain~e~ded b; CCR~ Title 19 P~9e 3 of 4 Date.of lnspection, Testing; Mai~enance: ~~ -. d~f Property Information: . Name: ~' J{'v~ i'~'~ C~° ~ r~' y~ Address: ~ Z~ ~VG ~ C~ ~ ~~,-.~' ~~ J~ ~~ Item 12 0 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2:19 2.20 2.21 2.22 2.23 2.24 2.25 3.1 3 2 ~~ -~ 3.3 3.4 3.5 ~~~~~ Actlvity ~ Frequency ' Desc~iptlon T Annually Dry Pi e V i N P a ve - P~tmmy Water 12.4.4.2.1 T q~~~~~Y Dry.pipeValve.-Low:Alr.Pressure Aletm . . 12.4.4.2.6 T Annually ~ ~~Y P~Pe V~~e.-puick-0pening Devlce' 124.42.4 T ' Annually Dry ~Pipe Vaive - T~ip Test 12.4.4.2.2 ~ T Annually Backflow;PreventerAssemblfe$ ~2,g.z T 3 Years bry Plpe Valve- FuII Fivw~Trip Test 13.4.4.2.2.2 T 5 Yeara Gauges 5.3.2 T 5 Years Pressure Reducing Valve 12.5.1.2 T ~ Years Fire Department Connec~tfon Backflush 12.7.4 ' T 5 Yeers 5prinlders - Eztra;FG~h:Temp~erature 5.3.1.1.1.3 T 5 Yeara ' Sphnws~`- C~~S~~ environment or co[rosive:;water 5.3.1.~.2 . T ~0 Years. Sprinklers - Dry ' 5.3.1.1.1.5 T 20 Yeara Sptinklera - Faat Responae 5.3.1.1.12 T 50 Years Sprinkiers ~ 5.3.1.1.1 T 75 Years Sp~inkiers,75 years;in aervice 5.3.1.1.1.4 Sp~inkle s m fa T r anu cture~i~prior to 1920 -Re ace ~ 5.3.1.1.'1.1 M Annually Corrtrol V.alvea • 12,3:4 M Annually PreactionLDeluge Val~es 12.4.3.3.2 V i Pip - ~ M Annually • e a N ~es/Qt~(.c..k .Opening Devices 12.4.4.3.2 M Annuatly Dry Pipe. Valve - Low.Pa~ Drains 124.4.3.3 M 5 Years Obstrudion Investigation Chapter 13 System Riser ID: ~ Type of System: ~Wet P(pe ^ Dry Pipe ^ Preaction ^ Deluge Fail N/A . Pass ~ ~~ ~ ~:: ~ ~ ~ State Fire Marshal AES 2 • ~ ~ Mareh j21, •2006 .. 23-82 INSP'ECTION, TESTIl~iG, AND MAINTENpNCE OF W~TER:BASED FIRE PROTECTTON SYST'EIvIS inspection, Testing~ and Maintenanee Fire Sprinkler.System Page 4 of 4 N~PA. 25 Cha ter 5 aa-amendec! b' ~:CR~ Titfe 1;9 ' _ _o. ,::: Date of Inspedion; Testing, Maintenance: ~' ~i Z- ~ System Riser ID: ~_ Property Information: Name: ~~ ~(~ ~~'~ ~ C.~ ~ Type of System: ~ '~Wet Plpe Address: ~' Z.UO ~S VG~G~ Cr,>J~.S . ~'"Dry Pipe , j ^ Preastion ^ Deluge CitY ~~F~~ L~IP( Item Defi~iende~:and Comments: Deflctenc,iQS.and.Comments..item number muatoorr<espond tothe.l.bem number • of the Acttul _ . .l[sted above: ~ •~ ~ _~ ~r: O See Continuation Page(s) (Indic umber~of continuation pages) ~C PASS ~ FAIL .~~.,~p y S nature Date / : State Fire Marshal AES 2 March:31; 200.6 ~ lns~~.~s~n, T~~t~~~=~tt~~ ~r~~s~~trt~e3~~._v,~r ~he~t . ~ , :; . ~ N~~' ,~3 ~ ` x ~ ~ ~d;~ G~•R . ,. f Titi,~:19 Pi~o : ~ , , : Aerty.I~fo~a~Qn: . , , , _ ~ Naine: Q,C,;b . cl!Eit> 'l~ ~ /Z I . i 4 ~ Oc~up~ncy /Use: ~ .Address:. 3 ~ ~9-~' G t . I ;ons . ruetion T~pe Gity. ~ .~ No Stories; . . ~ ZIP: Year C:Qnstructe-. d:. . Coc~tact: . ° Telephone: L~'~,"' ~- ._.:., ,~ .. .: . ~ ~_ ontractor.IrrforrnaUon: . ' ~~;~,~~, ~ ~ ° o~aa;~a:ny Number: of. S sfi.em °F~is,e,rs y ~ 2~91 S. East A~ve ~ „ copy sent to: ~t . ~~p~:t~:p : ~ o Owner Date ,~ y{ C/4. ~~~QS ~ `` / • ,t~ire AHJ Qate ~/ "~ U.~ "/ 9 - :~: . ~' ` `"'._ 5~~~ ~~ ~~;'f . ... a .C 'o,ntractor Date ~ ~ ~ ~~~~~ ~ . ~ NOT~S 1) For s~ec_if~c in~pecti.on~ t~stl~ ~ nd ' ~ ~ Job # . • . ma~~ten~n~e r~q,~~r~ements a d i " ' a~ian~ see ~I~PA 2~, ~Q02 ~di~~l;c~n as a ~ ~jy: ~ ~~~ . PetFo[med;p :~ .. ~ ~ ~ .~, Cal~fqm~a,Code b.f I~egulatlort8~'~~1~t.~`~~ §~9:~.1 tc §9.:06. . . (P~~~ . 2) lnspec~on items maY L~ perto cifrll~a by the Owner in accordance vintt~ ~~I~fgrnlai.,,~~tle~of: Re~ulat~ana Trtle .19 ~gQa 14~) F f P . orms in~l~~:;~vltfi tt~ls.:report . N ~ ~,2a Gta~t iet Number of.For,ms N/A F,qIL" RA. S8 0 A~toma~ic, Sprir~~r ~yatem O Stan~Rt pe a~d M s ~ ~ 'S. • . .. . , . , ; o e yste .ms . . ~ Priuata W~~r S~~aR1~r ~~stsm 6.. ~Fire>Pump 7 . ^ Vllater Starage Tank ~ . 8 . -- - <--- O Water- SPraY S~tste~t ~ ~ 9 ~ . O Foam Water Spnrakler S~istem - ~p . 11 , ~e 'De~ci~ndes ~nd Gomments' s~t~jqn at ~nd pf.each .respec~ive form_ State.Fire Marshai AES 1 ~March:21..2006 25-88. 1NSPECTION, TESTIIVG, AND MAINTENAIVCE OF WATER-BASED FIRE PROTECTION. SYSTEIVIS ' Inspection~ TeSt~ng, and Maint~n~n~e Fire=Pumps " P~ge 1 of $. N~PA 25; Gha ter 8 as~a „ endgd. b_ .=CCR;;:T~tle 1,9~ , :. ,,, . , , _..,: _..:. . ~, L~~ Date of Inspection, Testing, Maintenance. ~/~ ~~ g Pump ID: Cpl~~i~'X', ~ ,: ~~~ :.' • ProRerty Ic~#ormation: ' Serial Number: ' "'~ ~~~ ~ , ' . ;~ ~ Name ~~ `' ~ .:: S : : ~c~2~7Ti~~2 j~- ~- ,~r~ ~ . ~ ' - , ~~ L+ s~~ 4 ~ ,' ... 2 A6Ei~eviation . Key: Address- v~ („)C:>~~B~~a.~ I = inspection ~:~P~ C~ ~ T = Test fV1 = Maintenance _1~,.t/ri1~L.~~~~~c.,~(J A-O = After Operation City: MI = Per Manufacturer's Instructions AnnuaL Flre P~mp Test Results Date of Pump Test: ~~ S O Number of pumps at this location: ~ Type'of D~iver.. ^ Electric Shaft Orientation: _ If multiple~pumps: ^ Series arrangement Diesel ~ Nocizontal '~ ' ^ Parallel arrangement O :Gasoline ~ S team ^ Vertical; NOTE:.:Submit a sep;arate form for each purnp , ~Gas . Nameplate Data . Test Results ShutofF Pre.ssure ` ; psi ~ , , . , ; F/ow (gpm) , Nef pump Pressure (psi) RPM Vo/ts `' , Am s ~° 100%'Rated . _... ... , ~ Capacity ,/ ~ 9P ! ~~d m ~ ~ ~~6 ~ . ~ C ~~J ~ ~ .1.OOJa Rated Pressure ~~ psi ~ 15Q%o Rated Gapacity . `)c ~,GJ Z~ gp"i ~ ~~~~~~ . ~ 65%0 _ Rated Rressure ~Z psi . Rated ~RPM / ~ ~ rpm Type.of Test: ^ Discharge to Atmosphere , ~ Recireulation Test Eguipment ~ ~/~ /~ Flow Meter / Size:. _ Controller; 0 Play pipe (1-1/8") ~ Manufacturer: O.. Play pipe (1-3/4") ~ // ' Diffuser / Size: Serial<Number: ~ /~~~ ~.. State Fire :M.arshal AES 5 Ma.,r,ch ,2;1,; 20Q6 '~ ins.pection, Testing, and Maintenance Fire.~Pumps Pag;e 2 of 8 NFPA 25; .Cha ~'fer $kas amended jb. ;; GCR; Title 19 I', Date_o,f Inspection, Testing, Maintenance: ~l'~~-',6 ~ Pump PD~yL~~~~ , Property lnformation: , ~ 1 i Serial Number: ~~~ y~~~~~~~ :' Name: 61.~ I-VR . /l~1"1Z~P--~ ( "~T~ ~ ~ ~ ~Iy~~~~"' ~ "~ ~ ,.,~ ~: Address:~. ~Z~d // ~UG'~c~~~ Abbreu:iation Key: ' ~,k` ~` ,F,, ;~ti ~" 1 = inspection ; ~_~ T = Test .4 S.rJdL1 - M =. Maintenance y ~~~ Cit : ~~(~ A-O = After Op,eration M1-= RerManufacturer's tns~ructions, ; .. . FIR~fiUMP INSP,ECTIONS ? Item _ _ Activity . Frequency _ ._ .... , . Descciption ' "NFPA 25 Reference Fail _. N/A ~ .. Pass • 1.1 I Weekl y Pprnp~ House heafiing and>ventilafiing 8:2:2 ~ ~ ~ ~ louvers 1.2 I Weekly Circulation ReUef Valv~ ~ 12.5:6.1 . 1.3 ._ .. I eekl:y , ..... , Peessure Relief Value 2.5:6:2 ..,. . ,.. 1.4 I Quarterly ,. Control Valves -~ . 12.3:2:1 "' Fire. Pum.P $ystem:. - 8.2,2(2) :5 I _.. . _ eekl.y a. Pump_Suction,.discharge, and " ' ~'?~2~~a~ ,. ... :, ~ ,;.. ..., b, ass valVes are~:o en: 1.6 I Weekly b. RiPing is. fir~e of leaks. . 8 2:2(2)(b) 1.7 I Weekly a Suction pressure gaug.e reading is ; , . 8 2 2~2~~~~ , x ; normal „ 1.8 I Weekly d. Sysfem line pressure gauge , _ ~ 8 2:2(2)(d) ~ r~adin is notmal ~ . . 1.9 I Weekly e. Suction reservoir is full. ' 8.2.2(2)(e) 1.10 I Weekly f, Wet pit suction screens are - ` 8 2 2(2) (f) " unobstructed and iri ~ lace~ . ~~. Electrical S.Xstem. Cor~ditions,: 8 2~2(3) 1.11 I Weekly a. Controller pilot light is illuminated.. 8 2.2(3)(a.j , ,:, . .,_ . 1.12 I Weekly b. T~ansfer switch"normal pilot light is 8 2.2~3)(b) illuminated:- 1.13 I Weekly c. Isolating.switch is closed - standby $ 2 2~3,)(c) ~ .. eme.r enc. ; , source. ,_ d. Reverse:phasE,alarm pilot light is ~ `f -. 1.14 I Weekly off or normal phase rotation pilot light ` ~` 8:2.2(3)(d) X ~ is:on. ~ 15 1 I Weekly Oil level in;.vertical::motor:sight gl.ass is ` 8.2 2~3)(e) . normal.• _ , ;Diesel.:Engine:.System Conditions: 8:2:2(4:) - 1.16 I _. V1leekly ..:. a. Fuel tank is two=thirds full: .: 8 2:2(4.)(a) ,, State Fire Atlarshal AES 5 4Utateh 21;: Z-0D:6' ~ • .. I ~. 2~S=9U. INSPECTION, TESTING, AND MAINTENANCE:QF WATER-BASED FIRE PROTECTION SYSTENIS , ,,P~, I Date of Inspe~tion, Testing, Mainternance:-: ~~~~vdO P.ump-,ID:~~ .~~. _ - . Property InfQrri~ation: ` ~ . ~~ Serial N,umber: _ ~'` ~'~ ~ ~ ' _ , . .. .. Name: ~~U -' i"C~~~ ~ ~, . . r , M1+. . (p1Q~~6'7 ~ ` ~ ~ Add ~~a~ ~C~'~~~~~ e Abb~eviation Key: ` F: I = I ti s l~~ ~ r ss_ n pec on , .~ , , ~ (~ _..; ~.. T = Test ~ <l~ . M = Maintenance A-O = After Operation City: MI = Per Manufacturer.'s lnstructions ; Item Activity Frequency ' Description NFPA 25' Fail N/A Pass _ ~.:. Re.ference , , . ., 1:'17 I Wee.kl y b. Controller selector switch is in u n 8:22(4)(bj , auto osition. 1.18 I Weekly c. .Batteries,(2) voltage~r<eadings are 8:?•?(4)(e) normal 1.19 I Weekly d. Batteries•(2) charging cur,rent r.. 8,2.2(4)(d) readin s.are:normal. , . _ ,. .. 1 ,20 I Weekly : e. Batteries (2) pilo..t~lights`:are.on or ' 8~2:2~4)(e) ~ . ._ . batter .fa ilure 2 Ir hts are off: 1,21 I Weekly f. .All alarm,pilot lights are off. 8.2:2(4)(f) 1..~2 I Weekly 9. Engine running_time met~ris 8.2.2(.4)(g.) readin .: 1..23 I Weekly h. `Oil level4in rigfit angle-gear drive is ,. 8.2.2(4)(h). normal. 1.24_ I Weekly i. Crankcase oil level is-normal. 8.2.2(4)(i) 1.25 I Weekly j: Cooling water:level is. normel: 8:2.2(4)Q) ~ 1.26 I Weekly k. Electrol e level;in batteries is- ~ 8:2.2(4)(k) normal. 1.27 I Weekly I. .battery fe~minals are free fr.om ro 8.2,2(4)(I) ' ' cor. sion. 1.28 I Weekly _ m: V1/ater Jacket heater is.operating. 8.2.2(4)(m) Steam System CQnditions: ` m 8.2.2:(5) ; _ _._. 1.29 I : ` ` Weekly Steam pcessure gauge reading.is .2.2(5) ,... '" . normal. , Pump $ystem ;:: ` Table 8.5.3(A) . _ 1:30 I A-O Wet pit suction screens Table ,. , 8.5.3 A 5 __ Electr.ical~ $ystem: Table 8.5.3(C) . . 1.31 .. I Annually Inspect ~m"e`~gency rnanual starting ` Table , means 8.5.3 C 4 Diesel.Engine System:. - Table 8.5.3(D) 1.32 I Weekly Fuel: Tank Level. Table 8.5.3 D 1 a: St9te Fire Marshal AES 5 March ~-21; 2006: ~ ~ : ,. ANNEX~ ~. 25=91 : -- Inspection, Test1_hg, arttl M~~nt:enance Fire:Pumps Rage 4 of 8 NFpA25, Cha ter8 as amended b":;CCR,~Title._'19 Date of insp_ection, Testing, Maintenance ~~ ~~v ~ P'ump ID. _ 1~ ~ Rrope~ty;lnfocmation: Serial Number: Name:: ~n~L) ~~1.~ ~~ ~~L t ~ lQ v ~Z~~ ~~y b~ ~~ Abtireviation Key: Address: L~ I = Ins_pection _ _ ~C.. VJJ . T = Test M. Maintenance ~~-; A-0 After OPeration City: `~~ T/ .~~ MI Per=Manu#acturer's Ir~structions Item Activiry Frequency De.scription . , NFPA25 Reference Fail N/A Pass _ • Table . 1.33 I Weekly Fue.l: Tank Float Swifch ' 8.5:3 D 1 b ;; ' Table 1.34 I Weekly Fuel:.Solenoid valv~.operation 8:5:3 D 1 c ` Table , , 1.35 I Weekly Fuel:. Flewble. hoses,and. connectors 8.5.3 D 1: ~ Ta61e 1.36 I Weekly Lubrication Systerri: Oil level. g.5:3 D 2 a. _ . . .,.. ` Table , 1.37 I Weekly Cooling Syst~m Level g.5,3 D) 3)(a) Cooling System: Adequ2te cooling water Table ~ 1.38 I Weekly - to heat excfian er. 8;5:3 D 3 d , , Table , 1.39 I Weekfy Cooling System: Water pumps. 8.5.3, D (3) f Cooling System: Condition:of flexible • Table 1.40 I Weekly i hoses and cgnnections. 8.53 D 3( Ta61e • . 1.41 I Weekly Cooling Systern :Jacket water lieater : g,5:3 •D :3 h - . ' Table 1.42 I Weekly . Battery System: Electrolyte level. 8.5:3.-D; 5: a Table 1.43 I Weekly ExhaustSystem: Leakage r 8.5~3 D 4: a - 1.44 I Weekly Electrical System::~General'inspection Table . 8.5:3<D: :6 a Table .. 1.45 I Mon#hly Battery System: Cl3arger.and cha(ge rate. g.5,.3;D 5) e; Table 1.46 I Monthly Battery System Equalize:charge. g-,5:3. D: 5 f Electrical Sy,stem:, :C.ircuit breakers: or ~ Table~ 1:47 I Monthl y fuses. 8.5.3 D).(6)(f) 1.48 I Quarterly . Lubrication.System:_;Crankcase breather . Ta61e 8:5.3 D 2 e Ex.haust System Insulation and fire ` " ~ ' Table ' • 1.49 I (Qua~terl y . hazards. ;. . , .3 D. 4. . c 8'S 1.50 . I - - Quarterly.:< Battery Sy;ste~n TeFmmals clean and tight. Table g:5.3 D 5 b . . .._. Electncal System:. Wire chafng where Table '. , ' 1.51 I Quacterly sub'ectto movin .'. 8.5.3 D 6 c ~ System .Antifreeze;rprotection •~ Gooling Table ' ` 1.52 I Semiannually ; level _ 8.5,3. D, 3 b) ., State Fire Marshal AES 5 Ma~ch ~1.; 20.06.. . • _. I ~ Z~=92 INSPECTION, TESTING, AND MAIN.. TENA3~T,CE::OF. WATER-BASED FIRE PROTECTION„S,YSTEMS _ . ~ Inspectiqn, Test4ng, a~td M~~ntenance Fire Pumps Page 5 of 8 _,, ~ :: NFPA 25,. G.ha .te.r;:8 as, ainendecl_ b C_CR,. Title 19 ' .. ...: Date of:lnspection, Testing, Maintenance: ~~5~~ Pump l '. . % ~ ~ ~G ~~ Se~ial Number: , ` s : ~~ Property Information: . ~ ~ , ' : , ~b - ~ ~l~T~~i~7~ ~~ / ~r ~ $~ ,~ ~~~ Name:. ~ ~' ,{ ~ -~~~ Atsbceviation Key: ~ '~ ; Address: ~~ ~"~~~ ~~R~~vT`~Y 1 = Inspection ' ~ ~~ t$~ - T = Test ~ ~~ ~ M = IVlaintenance . /~~- A-O - After Operation City:. 9B~~1~.) ~ MI = Fer Manufacturer's lnstructions . Item Activity Frequency Description NFPA 25 Reference Fail N/A Fa.ss 1.53 I Semiann~ally :Exhaust System: FlexiEile exhaust ;;se.ction. Table 8:5.3 D 4~, ..f: 1.54 I Annually Fuel:`°Tank vents and overflow piping is unobstructed. Table 8:.5.3 D 1, :h: 1.55 I Annually • Fuel: Piping. Table 8:5.3 D 1.i 1.56 I Annually Cooling SyStern Ins.pect,ductwork Table g;5.3 D 3 i 1.57 I Annually Exhaust 8ystem: Wangers:and supports. Table g..5.3 D 4 e - FIRE:'PUMP{TEST.S 2.1 T Weekly Fuinp Operation - No Flow conclition 8.3.1 2.2 T Monthly Engine Generator Sets. NFPA 110 2:3 T Annually Control Val.ve - Ro.~ition 12.3.3.1 2.4 T Annually . ~:G.ontrol Valve`- Operation 12.3.3.1 2:5 T Annually ` Supervisory 12.3.3.5 2.6 T Annually ' P.ump Operation - Flow condition 8.3.3.1 2.7 T 5 Year Pressure: R~ducmg;:Valve . 92,5:1.2 ~ ,.,.. 2,g T Automatic Transfer Switches NFPA 110 :=P:ump System: Table 8.5.3(A} . 2.9 T Annuall ~ y,._ P:ump`System: Check-Fump'shaft end . la : Table 8:5.3 A 2 : ` 2.10 T Annually Pump System: Check accuracy of ressure au es and sensors. Table 8.5.3 A 3 2.11 T Annuall y Pump System: Check pump coupling ali nment. Tatile 8.5:3 A 4 2.1'2 T Annually Pressure Relief Valve 12.5:6.2:2. , 2.13 T Annually Circulation Relief~Valve 12.5.6.12 State Fire=Maeshal AES 5 ~Maceh-2~1,~:2p0.6 , ~ .. . ANNEX,B 25-93~ In~pectio.n, Testittg, ~rrtd~M~tn:t~r~a~n~~a Fire~~Purnps ` Pag-e 6 of 8 N'~fA;2:5~ Ch~R~r,~8.,~~-arm~.!~.de~i.by~CCR, .T~tl~ 1;9 _ . __a. Date pf Inspe~tion, Testing, Maintenar~ce ~~~ . Pump ID: ° ~ ;~ ~ ~ -~~ ~ r~ ~~~#~ ~ n~" ,~ : . R Propetty lnformation: ~ n ., Serial Number: -,~~i - Name : Q1~U " ~(~ ~fV 1 l tJ~CLC [ I f`t" C~~~~'Z CT `~ '~: - . ~Z~ ~ J , Q C~ ~ ~ ~` \,~ ~X~ ~~ ~ ~ ~_ ; - Abbre~iat.ion Key, ~' ~ , 1 i'on ` ~ Address . ,= ,:= . - = Inspect -x: ~~ ~r;: ., ~V T Test $, r , cV . , M Ma.int.e.nance ~ ~ ~ .,.. A-O = After Operation City: ~ ~~~~ ~ ~_~ Mi Per Manufacture,rs Instructions ,' Itern Activity~ .. Frequency Descwption . NFP-A..25. Referenc.e ` Fail ~J~A ,: Pas`si _ . . ~ El.e~triGal S~stem: . .. . .: l`able 8.5:3{_C) :; : .,._.-.,_.. . ....._ .,_.,..-, ,. ., . ._. ~ Eiectrical Systern: Exerct~e isolating .. Table ,....., r . ::Y ,s s . .~ -'`'" 2.14 T Monthly switch and.circuit.breaker; 8,5:3 C 1 2:'15 T Semiannually ~lec,trical System -Op~r~te manu;al, .. ; Table < , . staC#in ,m~~.qs... ~f~~trical 8~ 5 ~ .C _3` _:.:- .m . . ~lectrical S~stem Trip ~ircuit br-e.aker; ' Table ~ ' 2.16 T Annually if,.rrlechanisrn~ rol~~d8d.. 8 5.3, C, 2 ~ ~leetncal Sys~em `dperate ernergency ~ ' Table 2.17 T Annually manual starting means (w~ithout ~ , g,5.3(C)(:4) X ower . Qie~el ~ngine System: :. T:able. 8.5.3(D) : 18 2 T Monthly Battery System:. Specif.ic.Gravity..oc Table . . . state of char e 8 5.3. D~. d .. Electrical 5ystem " Operation af " _:... Tabl;e " 2.19 T Serniannually . ~af.eties and:.al~r.ms. 8 5.3 D 6. -d ,.: :. Excessive baGk' Exhaust System: Table ~. 2.20 T Annually , iessure 8.5:3:D ~ d- ~ F.ire Pump~Malntenanee--(MFPA 25, 8:5.1) 3.1 M Annua.lly Control valves ~ ' 12:3;.4 ' Pum:p Sy,stem: Table 8.5;3(A) '.; _, __ 3.2 M .. _.. . : . . . . . Annually Lubeicate p.ump bsarfngs Table 8 5.:3: A 1. , .... .. Mecharti.cal_Tr~n~missio:n.; . . Ta.bfe_8...5.3(B:.) .., _ „ __. .,. _. Table , , ;., , . ~.,., 3.3 M Annually_ Lubricate C-oup.lm..,g 8,5:3 B~ 3.4 M Annually .Lubricate right a,ngle gear drive 1"~~ble 8.5:3 a6 2 ` `; :. • Efe~tri~al~Systema;. Table 8.5.3(.C) , - ,:. _.:. 3.5 . , M -._. _,...;_ nnually , ..:. ighten electrical connections _... . .. ... .. _ ... . Tabl.e 8.~.3 G S - : ~ ' Lubricate m:e~hanical rr»uing:paets .~ Table 3.6 M, Annually excludin star#~rs and.r~la s ~. 8,5:3 C 6 , State Fire Mar:shal AES 5 ~I~I:~rGh.:~~1;;.2QQ"6. •~ ~ 25-94. INSP_ECTION, TESTING, AND MAINTENANCE~OF WATER-BASED FIRE PROTECTION'SYSTEivIS i Inspection, Testing,:~and Maintenance` :Fire Pumps- Page -7-of. 8 NFPA;25; Cha ter;8'as,arnended;:b: CCR, Title'19 Date of.lnspection, Testing, Maintenance: ~~-' ~~~U Pump ID. ~~ ~~~~ Property 1nfo~rnation: ~ ~ - Serial Nurnber: ~~ Q9 ;~ , ~ , ~ Narne: C..ts~ -~ ~ ~ - j~` ~~ ~~ ~~ `~'(.~ ~ Ca'1- ,., Ab'bre~iation'Key: ~ ~ ~ ; tion I I Add~e VJ ~~ `~-~C ns ec - P ~~MA s s: T = Test ~LU~ . M.= Maintenance A-O = After Opecation ~ ~'~~ ~ MI = Per Manufacturer's Instructions City: ~, Itern Aetivity Frequency ~ DesceiptPon NFPA 25 Fail N7A Pass Reference Taple 3:7 M" Annually Calibrate pressure switch settings. g 5;3 ,C. 7 Table 3.8 M Annually Grease mofor beanngs 8:5.3 C 8 Diesel Engine'System: ; Table 8.5.3(D) a ble T ~ 3:9 M Weekly =Fuel: Water in sysfem: g:5.3 D 1 f l Ta r, filter, or dictleg, or Fuel; Straine b e 3.10 M Quarterly . combination.thereof 8.5:3 D 1,~d. bl Fuel: Water orforeign material in e Ta ~ 3.11 M Annually tank. 8.5.3 D 1 e Table 3:12 ' M Annually Gooling System: Antifreeze g:5.3 D 3 c Table Lubrication.System: 8:5:3 D 2 ~ ble Ta 3:13 M Weekly Lube oil heater 8:5.3 D 2 d bl T , e a 3.14 M Quarterly G~ankease breather g.5.3 D 2 e _ bl T 15 M Annuall 150 Oil change e a b 8 3 D 2 5 ~ 3. Hou s . . . bl T 16 : 3 M` Annually/50 a Oil Filter s ~) ' e a 8;5.3 D 2 c _ . - Hours. - Table Co.o.ling System: 8.5:3 D 3. Table , 3:17 - M Quarte~ly ~ Water Strainer , 8,5.3 D 3' til 3.18 M Semiannually Antif~eeze protection level. e Ta g;5:3 D 3 b. t l T i e a 3.19 . M Annually Rod out heat exchanger: 8.5.3 D 3 e Tab~ e 3.20 M Annually Clean louvers. 8;5:3 D 3 i 1'able Exhaust System: 8.5.3 D 4 Table 3,21 M Weekly Drain condensate trap. 8:5.3 D.4 b March 21, 2006 State Fire Marshal AES 5 ANNEX: B 25-95 . In~ ~'e+~tiot~,: T~~~i~.9~~, ~,, . ~y r~tl~l~$~ta~,~~a,r~~~ FFre ;Pura~ps ; Fage 8` of~8 1~:~~!- ~~,x~.~:a. ~~ ~~ ~ " ~I~.~,~~d,~i uCs~R,;Titl~~1;~ , ..,. ::.N.. ... .._ . Qate,of Inspe~tion, TeSting, MaintQnance: ~~~J 0~` Pump ID ; • : ~ ~. Propert~r Information: , Serial N,umber: Name: 6~ ~(,~ : ~ _ - tJ2.wJ /7~i2C C " ` , `~.,~/ ~ Abbrevi~ti~n Ke,y:. ' ~ ~ Addr,es.s: ~-b~ ~(~L~C ~(, ~ ~'~ I = Inspection £ T = Test:. ,. ~. ,;e>~ ~LIl~ , ~ M = fvl,ainter~ance n~ A-0 =:After O.perati.on City: ~~K~.~/ ~~~_ MI Rer Manufacturer's Instructions . Item. Actiyit;y Freq.uency ~ Description> .. NFPA-:25 , RefeFe~ce> F~il ~ Nf~A P~s~<. :~E~att~ry ~ystem; 3.22 M Monthly Remove corrosion, case:exteriorclean Table ` ~ - and dr . 8:5.3 ~D 5 c ~.E°Iectr.ical: System: . L ' ' Table 8:5:3 :D " 6 ,_ , _..... 3.23 M __ ;-:.-. Semiannually -Boxes, pa.nels, and cabinets. Table. . _:.. . .. ~ :..::.;. g,5.3 Q 6>,.e: 3.24 M Annualty Tighten control;~nd power winng~,. Table ' Connections. 8, 5 3 L). 6. b- 3.25 M Biannually :Circuit b[eakers and.fuses 'Table 853 D 6 ~/ J~ ; , ;. Defieiencie.s.;ar~d -Com~ents: Item . Def~~iienctes,and.Ca~r~tm.en~s. ltem number must.corresp;ond to~the item~numb'er of t~e~~.Gti~l,.~ liS~ted ~b,o~re:. . ,: , _ .. ,.. ; ~~ (~-~J _ _ ; •: , , ... ...; ~ ..: / ~ ~ ~ ~ See C~ntinuation Pa e s_~ Indi.cate the nu ; ber-of. con#inuation: Pages) ~ ~- sc~ c /~~" g PASS , . /~ ~~`~ ~~AIL .S~ r~~it~r:e . ..., . .~ ,; . C1~te.:...... , , State: Fire-Ma[s~ial~/~ES 5 ; Ma~t~i':~1';: ~~.(~6~- ~