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Report (43) The Electric Group f----pc Stoner Electric•Advanced Entry Systems •Commercial Electric•Stoner Controls•Stoner Protectivesy s�� FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. Protected Property Information Name of property: Address: Description of property: Occupancy type: Name of property representative: Address: Phone: Fax: E-mail: Authority having jurisdiction over this property: Phone: Fax: E-mail: 2. Fire Alarm System Installation, Service, and Testing Information Installation contractor for this equipment: Address: Phone: Fax: E-mail: Service organization for this equipment: Address: Phone: Fax: E-mail: Location of as-built drawings: Location of Historical Test Reports: Location of system operation and maintenance manuals: A contract for test and inspection in accordance with NFPA standards is in effect as of Contracted testing company: Address: Phone: Fax: E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. Type of Fire Alarm System or Service NFPA 72', Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers(if applicable): Alarm: Phone: Supervisory: Phone: Trouble: Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. If Chapter 8,note the means of transmission from the protected premises to the central station: ®Digital alarm communicator 0 McCulloh 0 Multiplex 0 2-way radio 0 1-way radio 0 N/A If Chapter 9,note the type of connection: ❑Local energy ❑Shunt 0 N/A 3.1 System Software Operating 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 6.6.1): Quantity: Style: Class: B 5. Alarm-Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system(see NFPA 72®, Table 6.5): Quantity: Style: Class: B 5.1 Manual Initiating Devices 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: ®Addressable ❑Conventional ❑Coded ❑Transmitter ❑N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of smoke detectors: Type of coverage: 0 Complete area ®Partial area 0 Nonrequired partial area 0 N/A Type of devices: ®Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A Type of smoke detector sensing technology: 0 Ionization ®Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: Type of devices: ®Addressable ❑Conventional ❑Coded ❑Transmitter ❑N/A Type of smoke detector sensing technology: ®Ionization ❑Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: ❑Complete area ❑Partial area ❑Nonrequired partial area ®N/A Type of devices: ❑Addressable ❑Conventional ❑Coded ❑Transmitter ❑N/A 5.2.4 Sprinkler Waterfiow Detectors Number of waterflow detectors: Type of devices: ®Addressable ❑Conventional ❑Coded ❑Transmitter 0 N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is:❑Enabled ❑Disabled ❑Set for seconds 6. Supervisory Signal-Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ®Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A 6.2 Fire Pump Type of fire pump: ❑Electric 0 Diesel Type of fire pump supervisory devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A Fire Pump Functions Supervised Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. ❑Fire pump power 0 Fire pump running ❑Fire pump phase reversal 0 Selector switch not in auto ❑Engine or control panel trouble 0 Low fuel Other: 6.3 Engine-Driven Generator Type of generator supervisory devices: 0 Addressable 0 Conventional 0 Coded 0 Transmitter 0 N/A ❑Engine or control panel trouble 0 Generator running 0 Selector switch not in auto 0 Low fuel Other: 7. Annunciators 7.1 Annunciator 1 Local 0 Remote Type:®Addressable 0 Directory 0 Graphic 0 N/A Location: 7.2 Annunciator 2 0 Local ®Remote Type: ®Addressable 0 Directory 0 Graphic ❑N/A Location: 7.3 Annunciator 3 0 Local 0 Remote Type: D Addressable 0 Directory 0 Graphic 0 N/A Location: 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker zones: 8.2 Telephone Jacks Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: 0 Electrically powered 0 Sound powered 0 N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system(see NFPA 72*, Table 6.5): Quantity: _ Style: Class: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device: Horns: With visual device: 23 Chimes: With visual device: Bells: With visual device: Visual devices without audible devices: 29 Other(describe): 9. Emergency Control Functions Activated ❑Hold-open door releasing devices 0 Smoke management or smoke control ❑Door unlocking 0 Elevator recall 0 Other 10.System Power Supply 10.1 Primary Power Nominal voltage: I2OVFW; Amps: Overcurrent protection: Type: ;kt {_i Amps: Location(of primary supply panelboard): Disconnecting means location: Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 10.2 Secondary Power Location: Type: Nominal voltage: Current rating: Number of standby batteries: Amp hour rating: Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: In alarm mode: 11.Record of System Installation Fill out after all installation is complete and wiring has been checked for opens,shorts,ground faults,and improper 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.) ►1 NFPA 72® ®NFPA 70®,Article 760 Manufacturer's published instructions 0 Other(please specify): System deviations from referenced NFPA standards: Signed: Printed name. Date: Organization: Title: Phone: r.) 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: NFPA 72® ®NFPA 70®,Article 760 ®Manufacturer's published instructions 0 Other(please specify): ®Documentation in accordance with Inspection and Testing Form(Figure 10.6.2.3 of NFPA 72®)is attached Signed: Printed name: Date: Organization: Title: Fr) Phone: 13.Certifications and Approvals 13.1 System Installation Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: ? r Printed name: Date: Organization: Stoner Protect, Title: Phone: 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: `NB Conti Date: Organization: Title: o e .u , Phone: 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: a'S Title: Phone: Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 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 Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications,its approved sequence of operations,and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 05/14/14 14 : 40 Stanley Convergent Security Solutions, Inc . Pg 1 Test Signal Activity Report For Dates 05/07/14 to 05/08/14 CID: 1117962196 Attn: FA WHOLE FOODS MARKET 12220 SW SCHOLLS FERRY RD TIGARD, OR 97223 Day Zone Event Time Comment 05/07/2014 SYS COMM 09 : 15 TRISH VANDER-MOOREN, TEAM LEAD SYS COMM 09 : 15 USER IN TEST MO 09 : 15 011 : 23 : 44 ZONE: 35 EQUIPMENT 09 : 17 CALL IN 09 : 30 TECH BERNIE COURY - STONER ELEC SYS COMM 09 : 31 CONSTRUCTION ON SITE - IN TEST UNTIL 090 SYS COMM 09 : 31 CHANGED - IN TEST UNTIL 0900 ON THE 16TH SYS COMM 09 : 31 TECH BERNIE COURY - STONER ELEC SYS COMM 09 : 31 USER IN TEST MO 09 : 31 008 : 23 : 28 ALL ZONES SYS COMM 09 : 34 TRANSF TO DATA ENTRY TO VERIFY ACCT INFO CALL IN 09 : 43 SYS COMM 09 : 43 SARAH CALLING IN USING TRISH ' S PC, SARAH SYS COMM 09 : 44 REQ TO MAKE CHANGES, ADVISED HER TO HAVE 32 TROUBLE 09 : 49 EQUIPMENT SUPERVISIONFIRE TROUBLE 32 RESTORE 09 : 50 EQUIPMENT SUPERVISIONFIRE TROUBLE 35 TROUBLE 10 : 00 EQUIPMENT SUPERVISIONFIRE TROUBLE 35 RESTORE 10 : 07 EQUIPMENT SUPERVISIONFIRE TROUBLE 34 TROUBLE 11 : 17 EQUIPMENT SUPERVISIONFIRE TROUBLE 34 RESTORE 11 : 18 EQUIPMENT SUPERVISIONFIRE TROUBLE 34 ALARM 14 : 20 EQUIPMENT SUPERVISIONFIRE SUPERVISORY-GA 34 RESTORE 14 : 20 EQUIPMENT SUPERVISIONFIRE SUPERVISORY-GA 34 ALARM 14 : 21 EQUIPMENT SUPERVISIONFIRE SUPERVISORY-GA 34 RESTORE 14 : 21 EQUIPMENT SUPERVISIONFIRE SUPERVISORY-GA 26 TROUBLE 15 : 03 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 RESTORE 15 : 04 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 TROUBLE 15 : 59 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 RESTORE 16 : 03 EQUIPMENT SUPERVISIONFIRE TROUBLE 05/08/2014 AT LOGGING 07 : 34 AUTOTESTPERIODIC TEST REPORT 26 TROUBLE 09 : 55 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 RESTORE 09 : 56 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 TROUBLE 10 : 07 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 RESTORE 10 : 08 EQUIPMENT SUPERVISIONFIRE TROUBLE CALL IN 10 : 12 TECH BERNIE COURY - STONER ELEC SYS COMM 10 : 12 TEST 1600 SYS COMM 10 : 13 TECH BERNIE COURY - STONER ELEC SYS COMM 10 : 13 USER IN TEST MO 10 : 13 000 : 05 : 46 ALL ZONES QUALITY 10 : 17 20 TROUBLE 10 : 29 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 RESTORE 10 : 30 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 TROUBLE 10 : 42 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 RESTORE 10 : 45 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 TROUBLE 10 : 45 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 RESTORE 10 : 46 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 TROUBLE 10 : 56 EQUIPMENT SUPERVISIONFIRE TROUBLE 05/14/14 14 : 40 Stanley Convergent Security Solutions, Inc . Pg 2 Test Signal Activity Report For Dates 05/07/14 to 05/08/14 Day Zone Event Time Comment 05/08/2014 26 RESTORE 10 : 56 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 TROUBLE 11 :46 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 RESTORE 11 : 48 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 TROUBLE 11 : 48 EQUIPMENT SUPERVISIONFIRE TROUBLE 20 RESTORE 11 : 49 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 TROUBLE 11 : 57 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 RESTORE 12 : 00 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 TROUBLE 13 : 42 EQUIPMENT SUPERVISIONFIRE TROUBLE 26 RESTORE 13 : 43 EQUIPMENT SUPERVISIONFIRE TROUBLE OUT OF TES 16 : 01 ALL ZONES Stoner Protective Systems A Division of The Stoner Electric Group FIRE SYSTEM INSPECTION AND TESTING FORM DATE:4-29-14 TIME: 11 am SERVICE ORGANIZATION PROPERTY NAME(USER) NAME: STONER PROTECTIVE SYSTEMS NAME:Whole Foods ADDRESS: 1904 SE OCHOCO ADDRESS: 12220 SW Scholls Ferry rd. REPRESENTATIVE:WB Coury OWNER CONTACT: LICENSE NO.:OR-2800LEA WA-COURYWB944OA NICET-130289 Level-3 TELEPHONE:503-462-6500 TELEPHONE: MONITORING ENTITY APPROVING AGENCY CONTACT:Central Station CONTACT: TELEPHONE: 1-800-649-2022 TELEPHONE: ACCOUNT#.: 1117962196 TYPE TRANSMISSION SERVICE El McCulloh ❑Weekly El Multiplex ❑Monthly ®Digital El Quarterly El Reverse Priority ❑ Semiannually ❑RF /1 Annually El Other(Specify) ❑Other(Specify) PANEL MANUFACTURER: Silent Knight MODEL NO.: 5808 CIRCUIT STYLES:B,Y,4 NO.OF CIRCUITS: 10 SOFTWARE REV.: 13 LAST DATE SYSTEM HAD ANY SERVICE PERFORMED: ALARM-INITIATING DEVICES AND CIRCUIT INFORMATION QTY OF CIRCUIT STYLE 1 4 MANUAL STATIONS ION DETECTORS 2 4 PHOTO DETECTORS 8 4 DUCT DETECTORS HEAT DETECTORS 1 4 WATERFLOW SWITCHES 4 4 SUPERVISORY SWITCHES 3 4 OTHER(SPECIFY):Ansul Systems ALARM INDICATING APPLIANCES AND CIRCUIT INFORMATION QTY OF CIRCUIT STYLE BELLS HORNS CHIMES 29 Y STROBES SPEAKERS 23 Y OTHER(SPECIFY):Horn/Strobes NO.OF ALARM INDICATING CIRCUITS: 8 ARE CIRCUITS SUPERVISED?EYES ONO 2 SUPERVISORY SIGNAL INITIATING DEVICES AND CIRCUIT INFORMATION QTY OF CIRCUIT STYLE BUILDING TEMP. SITE WATER TEMP. SITE WATER LEVEL FIRE PUMP POWER FIRE PUMP RUNNING FIRE PUMP AUTO POSITION FIRE PUMP OR PUMP CONTROLLER FIRE PUMP RUNNING GENERATOR IN AUTO POSITION GENERATOR OR CONTROLLER TBL SWITCH TRANSFER GENERATOR ENGINE RUNNING OTHER: SIGNALING LINE CIRCUITS Quantity and style(See NFPA 72,Table 3-6)of signaling line circuits connected to system: Quantity 1 Style(s)4 SYSTEM POWER SUPPLIES a.Primary(Main): Nominal Voltage 120 Amps Over-current Protection:Type Ckt Brkr Amps 20 Location(Panel Number):p2 c.14-1- 09 Disconnecting Means Location:By main Riser b. Secondary(Standby): Storage Battery: 12V Amp-Hr. Rating 7 Calculated capacity to operate system,in hours: ®24 ❑ 60 TYPE BATTERY LI Dry Cell ❑Nickel-Cadmium Sealed Lead-Acid 0 Lead-Acid ❑Other(Specify) c.Emergency or standby system used as a backup to primary power supply,instead of using a secondary power supply consist of one of the following: ❑Emergency system described in NFPA 70,Article 700 ❑Legally required standby described in NFPA 70,Article 701 ❑Optional standby system described in NFPA 70,Article 702,which also meets the performance requirements of Article 700 or 701. PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE: YES NO WHO TIME MONITORING ENTITY ® ❑ Stanley 11am BUILDING OCCUPANTS ® ❑ All 11am BUILDING MANAGEMENT ►1 El PIC 11 am OTHER(SPECIFY) ❑ ❑ AHJ(NOTIFIED)OF ANY IMPAIRMENTS 0 0 3 SYSTEM TESTS AND INSPECTIONS TYPE VISUAL FUNCTIONAL COMMENTS CONTROL PANEL ❑ ❑ INTERFACE EQ. LAMPS/LEDS FUSES PRIMARY POWER SUPPLY El E TROUBLE SIGNALS DISCONNECT SWITCHES Z El GROUND FAULT MONITORING SECONDARY POWER TYPE VISUAL FUNCTIONAL COMMENTS BATTERY CONDITION ® ® New 3-14 LOAD VOLTAGE El El DISCHARGE TEST El El CHARGER TEST SPECIFIC GRAVITY ❑ ❑ TRANSIENT SUPPRESSORS ►.1 REMOTE ANNUNCIATORS ® ® At Main Entry NOTIFICATION APPLIANCES AUDIBLE VISUAL ❑ SPEAKERS ❑ ❑ VOICE CLARITY ❑ ❑ INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS DEVICE VISUAL FUNCTIONAL LOC.&S/N TYPE CHECK TEST PASS FAIL FACP NAC#1 Trouble ® ►Z1 /./ ❑ FACP NAC#2 Trouble ® ® ® ❑ FACP NAC#3 Trouble ® ® ❑ FACP NAC#4 Trouble ® ® ® ❑ FACP Battery Missing Trouble ® ® ® ❑ Ground Fault Trouble ® 4 ® ❑ No AC Trouble ® 11 I1 ❑ 33:126 Above FACP Photo ® ® ❑ FACP Line#1(503-524-4209) Trouble ® ® ® ❑ FACP Line#2(503-524-4198) Trouble ® ® ® ❑ 33:127 Above 5496 IDF Rm. Photo ® ►1 - ❑ 33:101 Kitchen Ansul Aux-1 ® ® ® ❑ 33:098 Pizza Oven Ansul Aux-1 ® ® ❑ 33:097 Seafood Ansul Aux-1 ® ® ® ❑ 33:039 RTU-12 Supervisory ® ® ❑ 33:037 RTU-11 Supervisory ® ® ® ❑ 33:035 RTU-06 Supervisory ® ►/ /1 ❑ 4 INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS,CONTINUED DEVICE VISUAL FUNCTIONAL LOC.&S/N TYPE CHECK TEST PASS FAIL 33:034 RTU-2 Supervisory ® ® ® ❑ 33:032 RTU-1 Supervisory ® ® ® ❑ 33:029 MAU-2 Supervisory ® ® ® ❑ 33:028 MAU-1 Supervisory ® ►1 ® ❑ 33:026 RTU-08 Supervisory ►1 ® ® ❑ 33:025 RTU-7 Supervisory ® ® ® ❑ 33:023 RTU-5 Supervisory ® ® ® ❑ 33:022 RTU-4 Supervisory ® ® ® ❑ 33:020 RTU-3 Supervisory ® ® ® ❑ 33:004 Back Flow(x2) Tamper ►1 ® ® ❑ 33:003 Riser Tamper ® ® ® ❑ 33:002 Riser Water Flow ® ® ® ❑ 33:001 By FACP MP ® ® ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 0 5 INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS,CONTINUED DEVICE VISUAL FUNCTIONAL LOC.&S/N TYPE CHECK TEST PASS FAIL ❑ ❑ ❑ ❑ Cl ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Li ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ COMMENTS: 6 ON/OFF PREMISES MONITORING: YES NO TIME COMMENTS ALARM SIGNAL ® ❑ 8:15am ALARM RESTORAL ® ❑ 8:15am TROUBLE SIGNAL ® ❑ 7:00am SUPERVISORY SIGNAL ® ❑ 9:30am SUPERVISORY RESTORAL ® ❑ 9:30am NOTIFICATIONS THAT TESTING IS COMPLETE: YES NO TIME WHO BUILDING MANAGEMENT ® ❑ 3pm PIC MONITORING AGENCY ® ❑ 3pm Stanley BUILDING OCCUPANTS /1 ❑ 3pm All OTHER(SPECIFY) 0 0 COMMENTS: SYSTEM RESTORED TO NORMAL OPERATION: YES NO DATE TIME .1 ❑ TESTING WAS PERFORMED IN ACCORDANCE WITH APPLICABLE NFPA STANDARDS. NAME OF INSPECTOR: WB Coury DATE: TIME: SIGNATURE: OWNERS REPRESENTATIVE: DATE: TIME: SIGNATURE: WITNESSED BY THE AUTHORITY HAVING JURISDICTION YES❑NO❑ NAME OF AUTHORITY HAVING JURISDICTION: SIGNATURE: DATE: TIME: Stoner Protective Systems 1904 S.E. Ochoco St. Milwaukie, OR 97222 (503)462-5203 Fax(503)659-2824 Watts(800)548-2701 CCB#44823