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HomeMy WebLinkAboutReport of Inspection/Test - Inspection - 757 TURNPIKE STREET 3/10/2020 Report of Inspection/Test, Annual NFPA 72 IMPACT 03/10/2020 Conducted by.- Michael Rich F,"""I R E Property 26 HanVstdre Ddve,Hudson,NIH 0M I STOP&SHOP#92 Impact,Fire,Services-Hudson (603)2 0-1631 1,10073 201 B(Ooks Stmak Worwslet,MA 01M (W8)6524227 Buildin, VWMAETFIREPROTECTION.COM, I I g#*312311 767 TURNPIKE STREET NORTH ANDOVER M!A 01845 'STORE MANAGER 978-683-9666 Inspection and 'Testing For - Stop & Shop #92 wEST 2 Devices, Tested this Inspection Pass Fai"I Tested Not Total YTD Tested YT'D Exterior Notification Device 1 1 0 1 0 1 Strobe Device 6 6 01 6 0 6 Heat-Fixed Ternp 7' 7 Horn/Strobe Device 30 30 0 30 0 30 Manual Station 16 16 0 16 0 16 S,moke Det�ectoir 12 12 0 12 0 12 Duct Detectors 6 6 0 6 0 111� 6 Cop, right 2020 Inspect Point Page 1 of 17 'Y Report of Inspection/Test Annual , IMP,ACT 103/10/2020 Conducted by: Michael Rich FIRE Property 26 HanVshlte W,vel,Hudson,NH 03051 STOP,&SHOP#92 Impact Fire,Services-Hudson 110073 2611 Otooks Seek Vftce sleto MAO IM ,(&M)85�2-7227 Building#.',312311 MM.GETFIREPROTECTION-COM 7167 TURNPIKE STREET NORTH ANDOVER MA Oil 845 STORE,MANAGER 978-683-96616 Approvilng Agency Contact Name N/A Telephone N/A Email IN/A Service Type N/A System Type Control Unit Manufacturer N/A Model Number N/A Circuit Styles N/A Software Revision N/A Date Last Serviced N/A Last Date and Software or,Configuration N/A was Revised Power Supply Main Nominal Voltage, N/A Main Nominal Amps N/A Over current,Protection N/A Panel Board'Location N/A Disconnecting Means Location, N/A Secondary Standby Ni/A Storage Battery:Amp our Rating N/A Calculated Capacity to operate system Ni/A (Hours) Engine-driven g'ienerator dedicated to fire, N/A Location of fuel storage N/A alarm system Has Emergency System described in NFPA N/A Has Legally required standby,described in N/A 70,Article 700 NFPA 70,,,Article 701 Has Optional st andby system described in N/A NFPA 70,Article 702,which all so meets the, performance requirements of Article'700 or 701 Copyright 2020,Inspect Point Page,2 of 17 Report of Inspection/Test Annual NFPA,72, ICI PACT 03/10/2020 Conducted by: Michael Rich FIRE Property 26 HampsWe Ddve,Hudson,NH�030;51 STOP&SH'OP#92 Impact Fire Services-Hudson, (6,03)293-7531 110073 2,61 Wogs Street Wo(ce ster"MA 01606 (50)852-722? Building#:312311 MM.GETFIREPROTECTION.COM 767 TURNIPIKE STREET NORTH ANDOVER MA 01845 STORE MANAGER 978-683-9666 NOTIFICATIONS MADE PRIOR TO ANY TESTING Yes No N/A Who Tiornie Other(Specify) 0 0 R Monitoring Entity Ahold 12:30PM AHJ Notified 10 E] E) N.Andover Fire 12:30PNI Dept. Building Management Ia 0 0 Stop&Shop#92 1 2:30PM Building Occupants a 10 . 0 Stop&Shop,#92 12:30PM SYSTEM TESTS,AND INSPECTIONS Visual, F,unctional Pass,/Fafl Comments MNS,to Fire Alarm Interface N/A N/A N/A Interface Equipment Ye s 'Yes Pass Lamps/LEDS Yes Yes Pass Prerecorded Message Activation N/A N/A N/A Primary,Power,Supply 'Yes Yes Pass Prerecorded Message Content N/A N/A N/A Sound Pressure Level-Alarm N/A N/A N/A CCU Security Mechanism N/A N/A N/A Control Unit, Yes Yes Pass In-building MNS to Wide area MN"S N/A N/A N/A MNS,to,direct recipient,MNIS N/A N/A N/A System Intelligibility-CS1 N/A N/A N/A t Isolation Modules N/A N/A N/A Sound Pressure Level-Ambient N/A N/A N/'A Test Backup,Software N/A N/A N/A System Intelligibility-STI N/A N/A N/A Software Backup Performed N/A N/A N/A Reset/Power down Test Yes Yes Pass Supervision Yes Yes Pass Ground-Fault Monitoring Yes Yes Pass Disconnect Switches Yes 'Yes, Pass Fuses, Yes Yes, pass Copyright 2020 Inspect Point Page 3 of 17 Report of Inspect ion/Test Annual NFPA 72 I M PA.,C T 03/10/2020 Conducted by: Michael Rich Property FI,RE STOP&SHOP#92 Impact Fire Services-Hudson 26 H,an*shke Mve,Hudson,NH 03051 (603)293.763,1 110,073 261 Brooks Street Wxoesterl.MA 01605 B,ui'ldlll,'ng#:312311 (60)81612-7227 767 TLIRNPIKE STREET ~GETFIREPROTECTIONCOM NORTH ANDOVER,M�A 01845 STORE MANAGER 978-683-9666 Remote Annunciator N/A N/A N/A .......... Other(Spec[�) N/A. N/A N/A Functional Test Yes, Yes Pass UPS Power,Test N/A N/A N/A Trouble Si Ignals Yes Yes Pass Local"Annunciator Yes Yes Pass I FRCP Fire,Alarm to MNS,Interface Power Extender Panels Yes Yes Pass Booster Planel,above ceiling by floral SECONDARY POWER vi s U a I Functional Pass/Fail Comments Load Voltage Yes Yes Plass Discharge Test Yes Yes Pass Charger Test Yes Yes Pass Battery Condition Yes 'Yes Pass Specift Gravivy N/A. N/A NI/A Translient Suppressors N/A N/A N/A Remote Annunciators N/A N/A N/A NOTIFICATION APPLIANCES Visual Functional Pass/Fafl Comments Speakers N/A N/A N/A Audible Yes Yes Pass Voice Clarity N/A N/A N/A Visual Yes Yes Pass EMERGENCY COMMUNICATION Visual Functional Pass/Fail Comments EQUIPMENT Area of Refuge Communication System N/A N/A N/A Radio Communication Enhancement System N/A N/A N/A. .Amplifier(s) N/A N/A N/A System Performance N/A N/A. N/A Phone Set Yes Yes Pass Phonlejacks Yes Yes Pass Off-Hook,Indicator Yes Yes Pass Copyright 20,20 Inspect Point Page 4 of 17 Report of Inspection/Test, Annu�,al NFPA,72 IMPACT 03/10/21020 Conducted,by: Michael, Rich FIRE Property i 26 HanipsNre Dave,Hadsoft*NH 03051, STOP&SHOP#92 Impact Dire Seri -Hudson (M)291.7531 110 07 3, 261 Brwks Sbv a�'Wcwcd slar.MA 0 t,606 (SM)852-7227 Building#:31,2311 767 TURNPIKE STREET NORTH ANDOVER MA 01845 STOREMANAGER 978-683-9666 System Audibility N/A N/A N/A Other(Specify) N/A N/A N/A Tone Generator(s) N/A N/A N/A. Call-in Signal N/A N/A N/A System Intelligibility R/A NCl/A N/A Elevatior Emergency Com munication System, N/A N/A N/A AUXILIARY FUICI ONS/IINTERFACE Visual Functional Pass/Fail Comments EQUIPMENT/SPECIAL HAZARDS Smoke Damper Operation N/A N/A N/A Door Unlocking N/A N/A N/A Elevator Shunt Trip N/A N/A N/A Fan Shutdown N/A N/A N/A Door-Releasing Devices N/A N/A N/A Ot�her(Specify) N/A N/A NIA MNS Override of'FA signals N/A N/A N/A Smoke Management/Smoke Control N/A N/A N/A Elevator Recall N/A N/A N/A Smoke Shutter Release N/A N/A N/A SUPERVISING STAT,ION, MON 17OR1 NG Yes No N/A Who Time Alarm Restoration El 11 Ahold 3:00PM Trouble Signals R) 0 01 Ahold 3:OOPM Supervisory Signal 10 10 0 Ahold 3:010PM Alarm Signal Algol d: 3:00PM Trouble R,estora,l El Ahold 3:00PIVI Supervisory Restoration R1 0 01 Ahold 3:100PM NOTIFICATIONS'THAT TESTING IS COMPLETE Yes No N/A Who Time Building Management 91 0 0 Stop&Shop#92 3:100PM A Notified,, 21 0 0 N.Andover Fire 3:00PM Dept. Monitoring Agency R) 0 0 Ahold 34:00PM Building Occupants, 9 D Stop&Shop#92 3:00PM Cloplyright 2,020 Inspect Point Page 5 of 17 Report of Inspection/Test Annual NFPA 72 IMPACT 03/10/202,01 Conducted by: Michael Rich Property FIRE 26 Hanipstirs Ddve,Hudson�,�NH 0305t STOP&SHOP,#92 Impact Fire Services-Hudson (6w)293-7531 1100'7'3 261 Bm'ks,Stra st Vftce sler',MAO IW Building#:312311 (508)852.7227 WMV.GETFIREPROTECTIOWCOM 767 TURNPIKE STREET N 0,RTHAN D OVE R MA 0 1845 STORE MANAGER 978-6,83-96,66 Other(Specify) Copyright 2020 Inspect Point Page 6 of 17 Kilupwrt f Inspection/Test Annual NFPA 72 IMPAC r 03�/10/2020 Conducted by: Michael Rich Property IFIRI,E STOP,&SHOP#92 Impact Fire,Services,-Hudson 26 He - C I dson.,NH 03051 (603)293-7531 `110,073 261 B,rooks SVeet Mcce stw,MA01606 Building#:3123,11 �508)852-7227 7'67 TURNPIKESTREET WiMGETFIREMOTECTION.COM N 0 RTH AN DOVE R,MA 0 1845, STORE MANAGER 978-683-96616 ............... INITIATING, SUPERVISORY, AND, NOTIFICATION DEVICE TESTS AND INSPECTIONS Ad d,ess Location Device Type Factory Measured Visual Functional Pass/ Setting Setting Fall 0217 Left Loading,Dock Manual Station Yes Yes Pass (03/10/ 2,020) 0211 Right Side Exit Manual Station Yes, 'Yes Pass (03/10/ 20201) 02,16 Left Rear Exit Manual Station Yes Yes Pass ('03/10/ 2020) Produce Horn/Strobe Device Yes Yes Pass (03/10/ 2,020) 0227 Lunch Room Manual Station Yes Yes, Pass (03/10/ 2020) 0204 Right Front,Entrance Manual Station Yes Yes Pass (03/10/ 2020) 0230 Left Rear Mezzanine Manual Station Yes Yes Pass (03/,10/ 1 2,020) 0205 Service Desk Manual Stiation Yes, Yes, Pass, (0,3/10/ 2020) 0233 Front Mezzanine Left Manual Station Yes Yes IPass (03/101 2020) 0232 Front Mezzanine Manu al'Station Yes Yes Pass, Cerit (03/1 W 2020) 0231 Cornpressior Room #2 Manual Station Yes 'Yes Pass (03/10/ 2,020) 0228, Compressor Room #1 Manual Station Yes Yes Pass (03/10/ 2020) Produce Horn/Strobe Device Yes Yes Pass (03/101/ 20201) Copyright 2020 Inspect Point Page 7 of 1'7 K,c,r%vp^0,Pftr't of Inspection/Test, Annual NIFPA72 IMPA,CT 03/10,12020 Cori&ctecl by: Michael Rich Property, FIR . 26 Hamo stdra DdveE,Hudson,,NH 030!51 STOP,&SHOP#9�2 Impact Fire Services- Hudson (M)2934531 11,0073 261 ks Stva t ftme s ter,MA 0 1,SM (50B)8512-7227 Building#:312311 MM.GETFIREPROTEOTION.COM 767TURNPIKE STREET' NORTH AN ,MA 01845 STORE MANAGER 978-683-9666 Address Location Device,Type, Factory, Measured Vismal Functional Pass/ Setting Setting Fail Beer&Wine Horn/Strobe Device Yes Yes Pass (03/10/ 2020) 0,124 Rear Mezzanine Left Smoke Detector, Yes Yes Pass (03/10/ 2020) 0108 LUnch Room Stair Smoke Detector Yes Yes Pass (03/1 o/ 2020), 0128 Front Mezzanine Smoke Detector Yes, 'Yes Pass Electric Room (03/101 2020), 0118 Rear Mezzanine, Smoke Detector Yes 'Yes Pass Center (03/101 2020) 'Yes Yes Pass Beer&Wine Horn/Stroble Device (03/10/ 2020) 0114 Cornpressor Room Smoke Detector Yes Yes, Pass (03/10/ 2020) 0136 Bank Manager's Office Smoke Detector Yes Yes Pass, (03/10/ 2020) 0131 Front,Mezzanine L ft Smoke Detector Yes Yes Pass (03/10/ 2020) 0134 Bank Electric Room Smoke,Detector, Yes Yes Pass (03/10/ 2020) 0112 Energy Management, Smoke Detector Yes Yes Pass, Room (03/101 2020) 0126 Front Mezzanine Smoke Detector Yes Yes Pass Center (03/101 2020) 0135 Bank,Customer Area Smoke Detector Yes Yes Pass (03/10/ 2020), 0109, Men's Locker Room Heat-Fixeld Tem P Yes Yes Pass (03/101/ 2020) 0123 Rear Mezzanine Area Heat-Fixed Temp Yes Yes Pass (03/101/ 2020) Copyright 2020 Inspect Point Pa,ge 9 of 17 me ur of Inspection/Test Annual NFPA 72 IMPACT 03/1012020 Conducted y., Mich�ael Rich Property STOP'&SHOD# 2 Impact Fire Services-Hudson FIREdson,,NH 0 1 NORTH A COVER MA 011, 5 STORE MANAGER 978-1683-9666 Address Location DeviceiType Factoryas ur Visual c i awl' I F ail Pass/ Setting Settng i 1 ' Rear Mezzanine Area Heat-Fixed Temp Yes Yes Piss (03/10/1 , 0120 Women's Locker Room 'eat-Fixed T u Pass (03/101 2 0116 Rear Mezzanine rrin Area Heat-iFixed Tempi Yes YesPass ,3/1 2,020) 0122 Rear Mezzanine Area Heat-FixedTempi Yes Yes, Pass (03/10/1 0113 Boiler Room Heat-Fixed Temp Yes Yes Pass (03/101/ 2 0125 Generator Room Smoke Detector Yes Yes Pass 3,11 22 raftsCiss'Cards& H rn/Str Device Yes Yes P Seasonal 2,020) Pharmacy Strobe DeviceYes Yes Pass 31 . 2 Aisle 21 Horn/Strobe Device Yes Yes Pass /1 22 Aisle 21 Horn/,Strobe i+ ", s Yes Pass 3 10/ 2020) Aisle 1 Florn/Strobei Device (03,1101 2020) Dalry Lieft Emergency tr+ vic Yes Yes Pass Exit 1 2 Loading mock Horn/Strobie Crevice Yes Yes Pass "1 22 2n 'Fl Mid Rear Horn/Strobe Horn/Strobe Device Yes Yes pass Mezzanine Stairs (103/10/ 202 2nd Floor Right Morn/strobe Device Yes "des Pass Mezzanine Stair 3/1 1 2 , Copyright 2020 inspect Point Page 7' Report of Inspection/Test AnnualNFPA7'2, I M PA C'T 3 1 2 20 Conducted . Michael Rich F�IRjE Property 26 HampshireChive.Hudson.NH 03061 STOP&SHOP# 2 lmpa t Firs S �i � -Hudson (�)293-7531 5W)852-7227 767 TURNPIKE,STREET NORTH ANDOVER MA 01845 STORE MANAGE - 3- 66 Address Location Device Type F , �r Measured Visual Functional Pass Setting Setting Fail 2nd Fl Rear zz by Horn/Strobe Device Yes Yes Pass i 2020), nd Fl Rear Flora/Strobe Device Yes Yes Pass Compressor 31 1 2 2nd F1 Rear Metz by, Horn/Strobe Horn/Strobe Device Yes Yes Fars. Electric Rm 1 1 22 2nd Fi Rear Mezz by Horn/Strobe Horn/Strobe Crevice Yes Yes Pass Heat Units 1 311 1 20'20) end Fl Rear Mezz Heat Horn/Strobe DeviceYes Yes Pees Unit Room#2 3 1 2020) 2nd Fl Rear Miezz Horn/,Strobe Device Yes "Yes Pass Hallway Mechanical (03/10/ Area 2020) i 2nd'Fl Rear Break ' rrnl tr be Crevice Yes Yes, Fees Room 311 1 2 ' ) Exterior of Buildingy Exterior Notification Yes Pass Bottle, turn Device /10 2020) Front Mezzanine Stair Horn/Strobe Device y6s "des Fees Entry, 1 1 2,020) -Bank Teller Area Florn/Strobe Device Yes "Yes Pass 1 1 1 2020) Lift Front.Entry Horn/Strobe Horn/Strobe Crevice Yes Yes Pass 31 1 2,020) Right Front Exit Horn/S,trobe Device Yes Yes Pass 3/1 2020) Front Mezzanine Top Horn/Strobe Device Yes Yes Pass of Stairs (03/10/ 2020) Women's Room Strobe Crevice Yes Yes Pass 1 1 2020) Men'Men's Roorn Strobe Device Yes Yes Pas 03/1 1 2020) Copyright 2020 inspect Point Page 11 of 17 K=j%wpft waft r IJ,-: f Ins1w3ection/Test Annual NF'PA 72 I M P,A' T 03/10/2020, Conducted by: Michael Rich Property FIRE 26 HarnpsNre Chive,Hudson,NH 03051, ST'OP&SHOP#92, Impact Fire Services,-Hudson (603)293-75,31 1100,73 26t B=ks Stmet:Vftcester,MA 016W B i ($W)852-7227 uilding#.*312311 VYWWG'ET'Fl R,E PROT ECTIOMCOM 767TURNPIKE STREET N 0,RTH AN D OVE,R MA 0 1845 STORE MANAGER 978-683-9666 Address, Lociation Device Type Factory Measured Visual Functional Pass/ Settin U Ig Setting Fall Deh Hallway Horn/Strobe Device Yes Yes Pass (03/10/ 2020), Emergency Exit by Horn/Str 1e Device Yes Yes Pass Res,troloms (03/10/ 2020) Bottle Return Room Horn/Strobe Device Yes Yes Pass (03/10/ �020) Yes as Rear Stock Room Stro�be Device Yes, P s (0:3/10/ 2020) By G M/H BC Cage .Strobe Device Yes Yes Pass (03/10/ 2020) Copyright 202,0 Inspect Point Page 12 of 17 Report of Inspection/Test, Annual NIFPA'72 I M,PA C T 03/10/2020 Conducted by., Michael Rich Property FIRE 26 Hamps,Wto Ddve,,Hudson,NH 03061 STOP&SHOP#92 Impact Fire Services, Hudson (603),243-7531 110073 261 BrooX!s$tme k V10"stef.MAO 1 W Building#1:3,12311 (5081,)1852-7227 MM.GETFIREPROTECTION.COM 76,7 TURNPIKE STREET' NORTH ANDOVER MA 01 845 STORE.MANAGER, 8-683-19666 Control Panel and Battery Readings, Location:Right Front Entry Manufacturer,, EST Modell:2 Dialer,Phone Number: N/A Alternate Phone Number: N/A Dact Test: N/A Primary Phone Test: N/A Seconary Phone Test: N/A AC Power Supply Volts DC Power Supply Volts, 1 Load Test W: Battery w/Charger, Battery w/Out AC D,C Charger 12 VAC 24 VAC 90% Battery Date AC Loss Causes, DC Loss Causes Battery Voltage&AH Ground Fault Trouble Trouble Rating 2018 Yes Yes 1,2V-1 8AH No Battery Voltage AH Battery Voltage,AH Battery Voltage AH Battery Voltage&AH Rating, Ratingw/Charger Rating w/Out,Charger Rating Under Load 12V-1 8AH Second Battery AC Power Supply Volts DC Power Supply Volts, Load Test W Battery w/Charger Battery /Out AC DC Charger 120 VAC 24 VDC 90% Battery Date AC Loss Causes, DC Loss,Causes Battery Voltage,&AEI ,le Troubl: Trouble, Rating ,2018 Yes Yes, 12V-1 8AH Battery Voltage AH Battery VoIt'lage AH Battery Voltage Ahl Battery Voltage&AH Rating Rating w/Charger Rating w/Out Charger Rating Under Load 12V-1 8AH Comments This is the FACP ........................... Copyright 2020 Inspect Point Page 13 of 17 meport of Inspection/Test Annual NF'PA 7'2 IIMPACT 03/10/2020 Conducted by.-I Michael Rich Property FIRE STOP&SHOP#92 Impact Fire Services Hudson 26 HanVlWre,Od'vie,Hudson,NH 03051 (603)293-7531, 110073 261 Bmks Swat,Wme s ler,MA 01 Building#.#312311 (W)$52-7227' MM-GETFIREPROTECTION.COM 767 TURNPIKE STREET NORTH ANDOVER MA.01845 STORE MANAGER 978-683-96,66 Locatiom.,Above ceiling by Floral Man,ufacturer: Model: AC'Power Supply Volts DC Power Supply Volts Load Test%: Battery w/Charger Battery w/Out Ac DC Charger 1210 VAC 24 VDC 90%, Battery Date AC'Loss Causes DC Loss Causes Battery Voltage&AH Ground Fault Trouble Trouble Rating 2018 Yes Yes, 12V-1 8AH No Battery Voltage AH, Battery Voltage AH Battery Voltage AH Battery Voltage&AH Rating Rating w/Charger Rating w/Out Charger, Rating Under Load 12V1-1 8AH Second IBattery AC Power Supply Volts DC Power Supply Volts Load Test Battery w/Charger Blattery w/O,ult AC DC Charger 120 VAC 24'VDC 90% Battery Date A,C Loss,Causer DC Loss Causes Battery Voltage, AH Troubl' Trouble Rating 2018 Yes Yes 12V-1 8A,H Battery Voltage AH Battery Voltage,AH Battery Voltage AH Battery Voltage&AH Rating Rating w/Charger Rating w/Out Charger, Rating Under Load 12V-1 8AH Comments Booster Panel Copyright 2020 Inspect Point Page 14 of 17 Report of I , Annual NFPA72 I','milli Mll� PA c 11,11 03/10/2020 Conducted by-,Mic,balel Rich Property, FIRE 26 HarTV�s hilro Me,Hu idson,NH 0305 1 STOP&SHOP#92 'Impact Fire Services-Hudson (60)293-7531 110073 261 Smks Street"Wicaster,FAA01606 (50)8512.7227 Building#:312311 WiMiGETFIREPROTECTION.001M 767TURNPIKE STREET NORTH ANDOVER MA 01845 STORE MANAGER 978-683-9666 Questions with Photos and Notes StOPA Shop#92, -EST 2 Local Annunciator Pass Notes: FACE' Stop&Shop#92 -EST 2 Power Extender Panels Pass Dotes: Booster Panel above ceiling byfforal Copyright 2020 Inspect Point Pap 15 of 17 Report of In "" ction/Test Annua] NF'PA72 I M PA 11 T 03/10/2020, Conducted by�.- Michael Rich Property F, IRE STOP&SHOP#92 Impact Fire Services,-Hudson 26 Ha nVsWo Wve,Hudson,N,H0301 (603)293-7531 11,0073 261 Bmk$SUO 0 L Wbf,Ce Ver,MA 0 1606 B u i Id i ng#:1 312311 (508)852,7227 767 TURNPIKE STREET ~.GETFIREPROTECRON.COM, NORTH ANDOVER MA 01845 STORE MA,NA�GER, 978-683-9666 Deficiencies Stop&Shop#92 -EST 2 None Copyright 2020 Inspect Point Page 16 of 17 Report of Inspection/Test Annual NFPA 72 IMPACT 03/10/2020 Conducted by.- Michael Rich Property F I R INE STOP&SHOP�#92 Impact Fire Services,-Huldson 26 Han-OsWre�Ddve,Hudson,,NH 03061 3 (M)ea3-75311 1,1007 261 Rs Sm Stre ster,MA 016M Building#:31231"1 (W8)852-7227 '767 TURNPIKE STREET VOMAETFIREPROTECTION.COM NORTH ANDOVER MA 01845 STORE MANAGER 9,78-683-9666 Inspector Signature I state,that the information on this,form is,correct at the tiara and place of my Inspection,and all'equipmeat tested at this time was left in operational condition upo n completion of this inspection except as noted. Inspector Name Signature Date Completed Michael'Rich 20201-03-10 Copyright 2020,Inspect Point Page 117 of 17