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INSPECTION AND TESTING FORM <br /> DATE: �' '7 ZUo <br /> TIME: (- `(/- 9f"''‘ <br /> SERVICE ORGANIZATION PROPERTY/NAME(USER) <br /> NAME C5 S S C. NAME: JJ, / /-4;,c�2 a / <br /> ADDRESS: ell 12) I i-ct cf v✓ V i E vv RD ADDRESS: , 7.4- t�/'%� .�,4.�,�, 31.v./ (Al <br /> REPRESENTATIVE: )2,j {119 1'50,4 OWNER CONTACT: <br /> LICENSE NO.: CC Do 046 TELEPHONE: <br /> TELEPHONE: La(z- d <br /> MONITORING ENTITY APPROVING AGENCY <br /> CONTACT; f SSC CONTACT: ) 111-ej e. <br /> TELEPHONE: (n( g S 4 f OO o TELEPHONE: �1 1. / V _f l <br /> MONITORING ACCOUNT REF.NO.: y30 D 1 s <br /> TYPE TRANSMISSION SERVICE <br /> [ -]:-McCulloh [ ]-Weekly <br /> [ '] -Multiplex [ ]-Monthly <br /> Digital [ ] -Quarterly <br /> [ '-Reverse Priority kr-Semi-Annually <br /> [ ] -RF [ ]-Annually <br /> [ ]-Other(Specify [ ]-Other(Specify) <br /> PANEL MANUFACTURER: S �c; f� MODEL NO.: S'k �.Sr Z a 7 <br /> CIRCUIT STYLES: Cl4sr 9 <br /> NO.OF CIRCUITS: 5? <br /> SOFTWARE REV.: <br /> LAST DATE SYSTEM HAD ANY SERVICE PERFORMED: - ' 7- Zc' <br /> LAST DATE THAT ANY SOFTWARE OR CONFIGURATION WAS REVISED: <br /> ALARM INITATING DEVICES AND CIRCUIT INFORMATION <br /> QTY OF CIRCUIT STYLE <br /> Li 1h S 3 MANUAL STATIONS <br /> ION DETECTORS <br /> C"c 3 PHOTO DETECTORS ?Y <br /> DUCT DETECTORS <br /> / <br /> ( .135"" 3 HEAT DETECTORS <br /> / r I,4-sx /4 WATERFLOW SWITCHES <br /> e Gic r B SUPERVISORY SWITCHES <br /> 0443 7 OTHER (SPECIFY) Lvw <br /> ALARM NOTIFICATION APPLIANCES AND CIRCUIT INFORMATION <br /> QTY OF CIRCUIT STYLE <br /> BELLS <br /> /3 HORNS <br /> CHIMES <br /> STROBES <br /> SPEAKERS <br /> OTHER (SPECIFY) <br /> NO.OF ALARM NOTIFICATION APPLIANCE CIRCUITS: <br /> ARE CIRCUITS SUPERVISED? [ ]YES [ ] NO <br />