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� <br /> � <br /> 2405 ANNAPOLIS LANE <br /> MINNEAPOLIS, MN 55441 <br /> MONITORING 612-553-1180 <br /> SYSTEMS, INC. <br /> Name of Property ^ �'�t Report # �-� <br /> Property Address n , <br /> Receiving Station Notified ,�es no Time ' ,a � Date /v -i z- 9 ( <br /> Receiving Station Phone # ����-705�� Contact Person <br /> i <br /> 1. Equipment manufactured by G✓�.p-y W� �t Model # Serial # <br /> 2. Is control panel free of dust and dirt? (yes) no) <br /> 3. Is AC power on? (yes) (no) <br /> 4. Do control panel switches work correctly? (yes) (no) <br /> 5. Type of batteries - Size �-/�-V. (�e�/S , Amp Hours �� v <br /> 6. Are battery contacts clean? (yes) (no) <br /> 7. If dry cells, were they replaced? (yes) (no) <br /> 8. If trickle charged, charge voltage is o7�• � at �� � � ohms load <br /> 9. Battery test voltage is �.y��, �i under y��, / load <br /> 10. Are there any abnormal conditions when transferring from AC power to <br /> battery standby? (yes) �g„�,� <br /> 11. If yes, list problem <br /> 12. Is AC power supplied with a lock off device? (yes) <br /> 13. A.) Does system have a trouble light? (yes) (no) <br /> B.) Does trouble light work correctly? (yes) (no) <br /> 14. A.) Does system have an audible trouble device? (yes) (no) <br /> B.) Does audible trouble device work correctly? (yes) (no) <br /> 15. A.) Are the system's circuits electrically supervised? (yes) (no) <br /> B.) Does system's supervision work correctly? (yes) (no) <br /> 16. A.) Zs AC power supervised? (yes) (no) <br /> B.) Does AC power's supervision work correctly? (yes) (no) <br /> 17. A.) Is DC power supervised? (yes) (no) <br /> B.) Does DC power's supervision work correctly? (yes) (no) <br /> 18. System Initiating Devices <br /> Cleaning and <br /> When tested sends signal maintenance <br /> List below type Restorable or Now tested appropriately and/or performed <br /> of alarm initiating unrestorable ref. NFPA 72E properly activates aux. according to <br /> uan. device t pe Chapter 8 equipment NFPA 72E-Describe <br /> �3 � s �o ,. e S Sn'�ol�-e� Yes ( k) No ( ) NA ( ) <br /> .Z '�ta.�Fi o C� w��e Yes ( No O NA O <br /> tc. �.,'S �r,�o�c-�- Yes No ( ) NA ( ) <br /> `:6 � Oc ,� !;; Yes ( ) No ( ) NA ( ) <br /> Yes ( ) No ( ) NA ( ) <br /> Yes ( ) No ( ) NA ( ) <br /> Yes ( ) No ( ) NA ( ) <br /> Yes ( ) No ( ) NA ( ) <br /> 19. Other tests as required by equipment manufacturers: <br /> 20. Are all alarm initiating devices in good condition, unobstructed, free <br /> of damage or corrosion? (yes) (no) <br /> 21. Are all alarm initiating devices LISTED equipment, for the purpose they <br /> are being used? (yes) (no) <br /> 22. Are there any recent changes to the structure that require additional <br /> protection? (yes) (� <br /> 23. Are there any local detection devices independent of the automatic alarm <br /> system? (yes) no) <br /> 24. A.) If yes to 20, how many were tested? ��lO <br /> B.) Were they all working correctly? (yes) no <br /> C.) List type of cleaning and maintenance performed <br /> 25. Is wiring properly supported and in good condition? (yes) (no) <br /> 26. A.) ?^]here conduit is used, are solid connections made? (yes) (no) <br /> B.) Is conduit properly supported? � , (yes) � (no) <br /> 27. Does system signal local (X ) central station (�:� propri tory O <br /> 28. If central or porprietory, were signals corr�ctly received? ��yes (no) <br />