Loading...
Report (44) FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-33 • FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at time of system acceptanceandapproval. 1. PROTECTED PROPERTY INFORMATION -F135.Z-0 11 c cD p Name of protected Property; WaLMart Tigard Address: 7600 Southwest Dartmouth St Tigard,OR 97223 Description of property: Retail Sales Occupancy type: Class A Mercantile Name of property representative: Manager on duty c � t� Address: Klwtat'r' �1�'?ti5 a'- 7O) S -% C1 k . �'. 1.� . .De AR 727!C Phone: 674)273 aY) Fax: E-mail: Authority having jurisdiction over this property: ^'('°V F T Phone: Fax: E-mail: 2. FIRE ALARM SYSTEM INSTALLATION,SERVICE AND TESTING INFORMATION Installation contractor for this equipment: Airwave,LLC Address: 9865 NW 307th Ave North Plains,OR 97133 Phone: 503-647-5999 Fax: 503-647-7443 E-mail: holly@airwavellc.com Service organization for this equipment: Wal-Mart Stores Inc.;Security Services-Tech Address: #0610 702 S.W.8th Street; Bentonville,AR 72716-0610 Phone: (314)691-1318 Fax: (636)586-6130 E-mail: Location of as-built drawings: At Central Station/Premises Location of historical test reports: At Central Station/Premises Location of system operation and maintenance manuals: Protected Property A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Wal-Mart Stores Inc.;Security Services-Tech Address: #0610 702 S.W.8th Street; Bentonville,AR 72716-0610 Phone: (314)691-1318 Fax: (636)586-6130 E-mail: Contract expires: n/a Contract number. n/a Frequency of routine inspections: Annual 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE NFPA 72 Chapter Reference of System Type: Local,Proprietary Name of organization receiving alarm signals with phone numbers(if applicable) Alarm: Wal-Mart Alarm Central UL#S3152-1 Phone: (479)273-4600 Supervisory: Wal-Mart Alarm Central UL#S3152-1 Phone: (479)273-4600 Trouble: Wal-Mart Alarm Central UL#S3152-1 Phone: (479)273-4600 Entity to which alarms are retransmitted: Phone: (573)874-7391 Method of retransmission of alarms to that organization or location: Public Telephone Network ©2007 National Fire Protection Association NFPA 72 (p.1 of 5) Figure 4.5.2.1 record of Completion 2007 Edition 72-33 FUNDAMENTALS OF FIRE ALARM SYSTEMS 3. TYPE OF FIRE ALARM OR SERVICE(continued) If Chapter 8,note the means of transmission from the protected premises to the central station: 11 Digital alarm communicator ❑ McCulloh ❑ Multiplex ❑ 2-way radio ❑ 1-way radio ❑ N/A If Chapter 9,note the type of connection: ❑ Local energy ❑ Shunt q N/A 3.1 System Software Operation system(executive)software revision level: Site-specific software revision date: Revision completed by: 4. SIGNALING LINE CIRCUITS Characteristics of signaling line circuits connected to this system (see NFPA 72, Table 6.5.1): Quantity: I C Style: kr,-, Class: Lc 5. ALARM-INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: 3 Style: Class: 13 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: 1 Type of devices: 4 Addressable 21 Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: i Type of coverage: ❑ Complete area al Partial area ❑ Non required partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization , ] Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: IS Type of coverage: Required Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization kr Photoelectric 5.2.3 Heat Detectors Number of heat detectors: 0 Type of coverage: ❑ Complete area ❑ Partial area ❑ Non required partial area K N/A Type of devices: ❑Addressable ❑ Conventional ❑ Coded ❑ Transmitter al N/A 5.2.4 Sprinkler Water Flow Number of water flow detectors: if _/ Type of devices: A Addressable 1st Conventional ❑ Coded ❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: 0 Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for pip seconds ©2007 National Fire Protection Association NFPA 72 (p.2 of 5) Figure 4.5.2.1 record of Completion Continued 0 2007 Edition FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-35 6. SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler System Number of valve supervisory switches: 9 Type of devices: 4I Addressable ,i Conventional ❑ Coded ❑ Transmitter ❑ N/A 6.2 Fire Pump Type of fire pump: ❑ Electric ❑ Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter it N/A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other— IFP►'�ssure /V/?(3- 6.3 Engine-Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter _crN/A Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: /.\) 7. ANNUNCIATORS 7.1 Annunciator 1 Q Local ❑ Remote Type: LI Addressable ❑ Directory ❑ Graphic ❑ N/A Location: Service Desk 7.2 Annunciator 2 ❑Local El Remote Type: 0 Addressable ❑ Directory ❑ Graphic ❑ N/A Location: Entrance 7.3 Annunciator 3 ❑Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 8. ALARM NOTIFICATION DEVICES AND CIRCUITS 8.1 Emergency Voice Alarm Service 0 Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: iG`3 Number of speaker zones: I k 8.2 Telephone Jacks Number of telephone jacks installed: 6 4 Number of telephone handsets stored on site: Type of telephone system installed: tij Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: N /4 Style: Class: B ©2007 National Fire Protection Association NFPA 72 (p.3 of 5) Figure 4.5.2.1 record of Completion Continued 0 2007 Edition '72-33 FUNDAMENTALS OF FIRE ALARM SYSTEMS I 8. ALARM NOTIFICATION DEVICES AND CIRCUITS (Continued) 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device: Horns: With visual device Chimes: With visual device: Bells: With visual device Visual devices without audible devices: ! h____ Other(describe): 9. EMERGENCY CONTROL FUNCTIONS ACTIVATED old-open door releasing devices ❑ Smoke management or smoke control ❑ Other ❑ Door unlocking ❑ Elevator recall 10. SYSTEM POWER SUPPLY 10.1 Primary Power Normal voltage 110 Amps 20 Over current protection: Type: Circuit Breaker Amps 20 Location(of primary supply panel board): `� f� EDC#1 Disconnecting means location: I-11) 2-2 ( � 6o--G••9ad) CSCt Set Co. 10.2 Secondary Power Location: Control Panel Type: Battery Normal voltage 12 Current rating: 1.78 Number of standby batteries: 2 Amp hour rating: 18 Location of emergency generator: 1V 1,1 Location of fuel storage: N )A Calculated capacity of secondary power supply to drive the system In standby mode: 11. 1. L)g In alarm mode: 23- 6-) 11. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens shorts ground faults,and bnproper branching,but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards:(Note any or all that apply) Q NFPA 72 2 NFPA 70,National Electrical Code, Article 760 ❑ Manufacture's published instructions ❑ Other(please specify): Local requirements&amendments(if any) System deviations from, renced NFPA standards: Signed: C _- Printed name: Tc frea- , iO4.1'45) Date: 6/2.5)/LJ IF Organizati. : 1;,pct '1L Title: CGv (qPhone: (4)3/ii?-,--5,/c/ 12. RECORD OF SYSTEM OPERATION All operational features and functions of this system were tested by or in the presence of the signer shown below,on the date shown below,and were found to be operating properly in accordance with the requirements of: 0 NFPA 72 [] NFPA 70,National Electrical Code, Article 760 2 Manufacture's published instructions El Other(please specify): Local requirements&amendments(if any) 0 Documentation in • e* •ance with Inspection and Testing Form(figure 10.6.2.3)is attached Signed: -" Printed name: Ucc I1� Scy+S'� Date: E,'f //Lj Organize . : .A i i =GEve-- II C- Title: rte.k Phone(9 ?)6117"5"f ©2007 National Fire Protection Association NFPA 72 (p.4 of 5) Figure 4.5.2.1 record of Completion Continued ID 2007 Edition • FUNDAMENTALS OF FIRE ALARM SYSTEMS 72_37 4 13. CERTIFICATION AND APPROVALS 13.1 System Installation Contractor This system as specified he.-in has been installed and tested according to all NFPA standards cited herein. Signed: r, Printed name: it .- %Ua.PSct Date: -6/25)11 41 Organization: A t rt,/b.V`p..._ Title: 1 .C\-\ Phone:(5 03,G4-1 j w 5 q/`r(i 13.2 System Service Contractor This system as specified,,herein has installed and tested according to all NFPA standards cited herein. ...., Signed: .-------"\ Printed name: V a 5 NS4 Date:Cfi:.lj)4 L-17-5`�1 Organiza on: Wal-Mart Security Services Title: Alarm Technician/Proj Manager Phone: (479)273-4600 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Wal-Mart Security Services Title: Alarm Technician/Proj Manager Phone: (479)273-4600 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.5 Authority Havi • Jurisdiction I have witnessed a i*sfactory acceptance test. • ' system and find it to be installed and operating properly in accordance with its approved plan Y d specifieptierp,its app .ved sequence of operations,and with all NFPA standards cited herein. Signed: .- . . Printed name: (4(l 6 Afe_Alt21 I Date: / Organization: L TY[s 6, N Title:(•&ILL i Ali'to {k1 S 1 ./ Ihone:S33 7k5 Z6y47 ©2007 National Fire Protection Association NFPA 72 (p.5 of 5) Figure 4.5.2.1 record of Completion Continued 0 2007 Edition riRE ALARM AND EMERGENCY COMMUNICATION SYSTEM INSPECTION AND TESTING FORM To be completed by the system inspector or tester at the time of the inspection or test. It shall be permitted to mod(this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data, or calculations as necessary to provide a complete record. Date of this inspection or test: Time of inspection or test: 1. PROPERTY INFORMATION Name of property: Wal-Mart Tigard#5935 Address: 7600 SW Dartmouth St,Tigard,OR 97223 Description of property: Occupancy type: Me f(601.f,if_ Name of property representative: Y►1G f"?- 5'f ►re_s enc Address: 7Cj.? S W I^ k3i2Yi'otNV, k AR 7 27(C, -86 Phone: C 4 79)z7 3_ 100(2 Fax: E-mail: Authority having jurisdiction over this property: T'v F R Phone: Fax: E-mail: 2. INSTALLATION,SERVICE,AND TESTING CONTRACTOR INFORMATION Service and/or testing organization for this equipment: Wal-mart Stores,Inc. Address: 1106 SE 5th ST,Bentonville,AR 72716-0610 Phone: 479-273-8402 Fax: E-mail: SISOPS@wal-mart.com Service technician or tester: Qualifications of technician or tester: Factory Training,NICET Level II-Fire Alarm A contract for test and inspection in accordance with NFPA standards is in effect as of: Proprietary The contract expires: Never Contract number: N/A Frequency of tests and inspections: Annual Monitoring organization for this equipment: Wal-mart Stores,Inc. Address: 702 SW 8th ST,Bentonville,AZ 72716-0610 Phone: (479)273-4600 Fax: E-mail: A.Cserv@wal-mart.com Entity to which alarms are retransmitted: Phone: 3. TYPE OF SYSTEM OR SERVICE ❑Fire alarm system(nonvoice) Dit Fire alarm with in-building fire emergency voice alarm communication system(EVACS) ❑Mass notification system(MNS) ❑Combination system,with the following components: ❑Fire alarm 0 EVACS 0 MNS 0 Two-way,in-building,emergency communication system 0 Other(specify): N/A 3. TYPE OF SYSTEM OR SERVICE(continued) NFPA 72 edition: Additional description of system(s): 3.1 Control Unit Manufacturer: Bosch el 412- G V4-1 Model number: 9412GV4 3.2 Mass Notification System g This system does not incorporate an MNS. 3.2.1 System Type: ❑In-building MNS—combination ❑In-building MNS—stand-alone 0 Wide-area MNS 0 Distributed recipient MNS ❑Other(specify): N/A 3.2.2 System Features: ❑Combination fire alarm/MNS 0 MNS ACU only 0 Wide-area MNS to regional national alerting interface ❑Local operating console(LOC) 0 Direct recipient MNS(DRMNS) 0 Wide-area MNS to DRMNS interface ❑Wide-area MNS to high-power speaker array(HPSA)interface 0 In-building MINS to wide-area MNS interface [gOther(specify): N/A 3.3 System Documentation f$j An owner's manual,a copy of the manufacturer's instructions,a written sequence of operation,and a copy of the record record drawings are stored on site. Location: EDC in cabinet near CPU 3.4 System Software 0 This system does not have alterable site-specific software. Software revision number: N/A Software last updated on: N/A 0 A copy of the site-specific software is stored on site. Location: 4. SYSTEM POWER 4.1 Control Unit 4.1.1 Primary Power Input voltage of control panel: 16.5 V Control panel amps: 0.33 A Pre transformer,2.4 A post transformer 4.1.2 Engine-Driven Generator TifThis system does not have a generator. Location of generator: N/A Location of fuel storage: N/A Type of fuel: N/A 4.1.3 Uninterruptible Power System ,'This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: N/A Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): N/A In alarm mode(minutes): N/A 4. SYSTEM POWER(continued) 4.1.4 Batteries Location: Battery cabinet- Type: Sealed Nominal voltage: 12 V Amp/hour rating: P EDC 1 Lead-Acid Calculated capacity of batteries to drive the system: In standby mode(hours): 24 hours In alarm mode(minutes): 15 minutes Batteries are marked with date of manufacture. 4.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System 0 This system does not have an EVACS or MNS. 4.2.1 Primary Power Input voltage of EVACS or MNS panel: 120 V EVACS or MNS panel amps: 2 U 4.2.2 Engine-Driven Generator This system does not have a generator. Location of generator: N/A Location of fuel storage: N/A Type of fuel: N/A 4.2.3 Uninterruptible Power System a This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: N/A Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): N/A In alarm mode(minutes): N/A 4.2.4 Batteries Location: In Enclosure Type: Sealed Nominal voltage: 24 V Amp/hour rating: 12 Ah Lead-Acid Calculated capacity of batteries to drive the system: In standby mode(hours): 24 hours In alarm mode(minutes): 15 minutes 2(Batteries are marked with date of manufacture. 4.3 Notification Appliance Power Extender Panels 0 This system does not have power extender panels. 4.3.1 Primary Power Input voltage of power extender panel(s): 120 V Power extender panel amps: 4.3.2 Engine-Driven Generator 4A.This system does not have a generator. Location of generator: N/A Location of fuel storage: N/A Type of fuel: N/A 4.3.3 Uninterruptible Power System This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: N/A Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): N/A In alarm mode(minutes): N/A 4. SYSTEM POWER(continued) 4.3.4 Batteries Location: In each Type: Sealed Nominal voltage: 24 V Amp/hour rating: 7,S enclosure Lead-Acid Calculated capacity of batteries to drive the system: In standby mode(hours): 24 hours In alarm mode(minutes): 15 minutes Batteries are marked with date of manufacture. 5. ANNUNCIATORS Li 1'his system does not have annunciators. 5.1 Location and Description of Annunciators Annunciator 1: Customer Service Annunciator 2: Grocery Entry Vestibule Annunciator 3: 6. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: fj'i&( v' C att 'c c 1 Time: ap (s Building management Contact: 54c0- k\aritkYv3 'Ta Time: r OS Building occupants Contact: By PA announcement Time: 15: S Authority having jurisdiction Contact: Time: Other,if required Contact: Time: 7. TESTING RESULTS 7.1 Control Unit and Related Equipment Visual Functional Description Inspection Test Comments Control unit Lamps/LEDs/LCDs 0 Fuses 0 Trouble signals 14 Disconnect switches Ground-fault monitoring Supervision t Local annunciator Remote annunciators Power extender panels a. Isolation modules 0 0 IJ Other(specify) ❑ 0 Et 1'f 7. TESTING RESULTS(continued) 7.2 Control Unit Power Supplies Visual Functional Description Inspection Test Comments 120-volt power K X Generator or UPS 0 0 N I A Battery condition Load voltage 0 0 Discharge test 0 0 Charger test 0 0 Other(specify) 0 0 7.3 In-Building Fire Emergency Voice Alarm Communications Equipment Visual Functional Description Inspection Test Comments Control unit Lamps/LEDs/LCDs 12( 0 Fuses 4 0 Primary power supply t A Secondary power supply Trouble signals g. Al Disconnect switches , , A Ground-fault monitoring Panel supervisionA IA- System performance i. Sound pressure levels g K Tested by ear only Occupied 0 Yes I(No Ambient dBA Alarm dBA (attach report with locations,values, and weather conditions) System intelligibility R. aTested by ear only ❑CSI ❑STI (attach report with locations,values, and weather conditions) Other(specify) 0 0 7. TESTING RESULTS(continued) 7.4 Notification Appliance Power Extender Panels Visual Functional Description Inspection Test Comments Lamps/LEDs/LCDs AQ Fuses A `❑` A i Primary power supply ._ Secondary power supply 8. tga Trouble signals A_ ,i Ground-fault monitoring yekN. Panel supervision ,& A Other(specify) Vi. A. 7.5 Mass Notification Equipment Visual Functional Description Inspection Test Comments Functional test 0 0 N/A Reset/power down test 0 0 N/A Fuses 0 0 N/A Primary power supply 0 0 N/A UPS power test 0 0 N/A Trouble signals 0 0 N/A Disconnect switches 0 0 N/A Ground-fault monitoring 0 0 N/A CCU security mechanism 0 0 N/A Prerecorded message content 0 0 N/A Prerecorded message activation 0 0 N/A Software backup performed 0 0 N/A Test backup software 0 0 N/A Fire alarm to MNS interface 0 0 N/A MNS to fire alarm interface 0 0 N/A In-building MNS to wide-area 0 0 N/A MNS 7. TESTING RESULTS(continued) 7.5 Mass Notification Equipment(continued) Visual Functional Description Inspection Test Comments MNS to direct recipient MNS 0 0 N/A Sound pressure levels ❑ 0 N/A Occupied ❑Yes ❑No Ambient dBA Alarm dBA (attach report with locations,values, and weather conditions) System intelligibility 0 ❑ N/A ❑CSI ❑STI (attach report with locations,values, and weather conditions) Other(specify) N/A 0 0 N/A 7.6 Two-Way Communications Equipment Visual Functional Description Inspection Test Comments Phone handsets 0 0 N/A Phone jacks 0 0 N/A Off-hook indicator 0 0 N/A Call-in signal ❑ 0 N/A System performance 0 0 N/A System audibility 0 0 N/A System intelligibility 0 0 N/A Radio communications 0 ❑ N/A enhancement system Area of refuge communication ❑ 0 N/A system Elevator emergency ❑ 0 N/A communications system Other(specify) N/A 0 0 N/A 7. TESTING RESULTS(continued) 7.7 Combination Systems Visual Functional Description Inspection Test Comments Fire extinguishing monitoring 1g1 i/g1 devices/system Carbon monoxide detector/system ❑ ❑ N/A Combination fire/security system Other(specify) 0 0 7.8 Special Hazard Systems Visual Functional Description(specify) Inspection Test Comments ❑ 0 ❑ ❑ ❑ ❑ 7.9 Emergency Communications System Visual IS Functional ❑ Simulated operauix ❑ Ensure predischarge notification appliances of special hazard systems are not overridden by the MNS. See NFPA 72,24.4.1.7.1. 7.10 Monitored Systems Visual Functional Description(specify) Inspection Test Comments Engine-driven generator 0 ❑ N/A Fire pump ❑ ❑ ij I A- Special suppression systems Other(specify) 0 0 A 7. TESTING RESULTS(continued) 7.11 Auxiliary Functions Visual Functional Description Inspection Test Comments Door-releasing devices 0 0 N \A Fan shutdown ❑ 0 Each fan is shutdown by an independent smoke detector Smoke management/smoke control 0 0 N/A Smoke damper operation ❑ 0 N/A Smoke shutter release 0 0 f 1 Door unlocking 0 0 1' i Elevator recall 0 0 N/A Elevator shunt trip 0 0 N/A MNS override of FA signals 0 0 N/A Other(specify) 0 0 7.12 Alarm Initiating Device Device test results sheet attached listing all devices tested and the results of the testing 7.13 Supervisory Alarm Initiating Device I Device test results sheet attached listing all devices tested and the results of the testing 7.14 Alarm Notification Appliances Jgt Appliance test results sheet attached listing all appliances tested and the results of the testing 7.15 Supervisory Station Monitoring Description Yes No Time Comments Alarm signal // ❑ Alarm restoration 1^� ❑ Trouble signal 0 Trouble restoration 14 0 Supervisory signal 0 Supervisory restoration ❑ 8. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: Alu, Ce01— "e Time: Building management Contact: 5 t z '‘1Out1.04(10, Time: Building occupants Contact: By PA annoucement Time: Authority having jurisdiction Contact: Time: Other,if required Contact: Time: 9. SYSTEM RESTORED TO NORMAL OPERATION Date: C(25) ]14 Time: 10. CERTIFICATION 10.1 Inspector Certification: This system,as speci ied herein, been inspected and tested according to all NFPA standards cited herein. Signed: Printed name: `' s YThC Date: c A Organi .1 •n: al-mart Stores, Title: Alarm Tech Phone: Inc. 10.2 Acceptance by Owner or Owner's Representative: The undersigned has a service contract for this system in effect as of the date shown below. Signed: r' Printed name: Date: Organ' tion: Title: Phone: DEVICE TEST RESULTS (Attach additional sheets if required) Device Type Address Location Test Results INITIATING AND SUPERVISORY DEVICE TEST AND INSPECTIONS VISUAL FUNCTIONAL FACTORY MEASURED LOCATION &S/N DEVICE TYPE CHECK CHECK SETTING SETTING PASS FAIL 1 2 3 4 5 6 7 8 DC i Srnthc- 5j 7 L+t fur '( 9 1 cr incii,a e Aimee', 3i 5e'- k 10 10v-, 2 wo,4,r t w Alai- r1 3.7 s4.-- k 11. IG'.a 3 wo,--)-¢,( Ir,t,v -' P-1cs,,c+M 11) 3c..c X 12 410,.._) ''') w cxh'c 9 10 vJ 'C M G1/4.,( w•- 3 1 X 13 14 15 '1rkvvx ) Toyr 1/4:0\v-- Sirt-v5cA . X 16 'f'cern C' 2 la t '. 1 v32._ N / 17 i " c TCS 3 . tr vaAvc X �'C 18 ckm .c 4 Y1a jc�\ A i Ki 9 Tam _r -1 e�, ...c ‘;c.,v� X K20 c kf b's..,1 T r•/) 1 X 21 eckc h 0 v -' Tarte IN X 22 ac ti ) Tame 3 'r 23 13��;12ki � Tare L') X 24 25 !'a Sitti tat\ vvrtiva el X Akac ?(' 26 .2s'% Ri1 pikct •(%Inne,h&s h ivet•a.5c 1< 05-) it1ii N' t"i Ri (0 A/ A' 3/6z, it-Tv. t 1K �i �^ ogc"k, 1. ,X' X . 344,3 ¢-rtN )'--i K >( p-rkk ( G 64 j (2. 1-tA g7 X icy (kTti l a X X ,p X ?e.k 0\4.-c__ INITIATING AND SUPERVISORY DEVICE TEST AND INSPECTIONS VISUAL FUNCTIONAL FACTORY MEASURED LOCATION &S/N DEVICE TYPE CHECK CHECK SETTING SETTING PASS FAIL err2 Afit,& 3 45 46 Oe r\COCA 44.03e..41 c•c ( .ti.& t. +a• X Alar 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83