HomeMy WebLinkAboutFAI15-0037 Fire Annual Inspection ArchiveM
-M. .a:
dutte County Fire Department
Business Name:
California Department of Forestry and Fire Protection
Cp&-
Fire Prevention Bureau
Other:
176 Nelson Avenue, Oroville, CA 95965
a'
530-538-7888/530-538-2105(fax)
Building Owner:
Bus:
Other:
Fire Safety Inspection
Fire alarms stem defective
Business Address:
Business Name:
10.
caner/Manager:
Bus:
Other:
ther Contact:
Bus:
Other:
Building Owner:
Bus:
Other:
ddress:
Fire alarms stem defective
Occ. Class:
AN INSPECTION OF YOUR FACILITY REVEALED THE FOLLOWING:
1.
Fire extinguishers: required, service due
10.
Exit(s): obstructed, inadequate
2.
Extension cords: Excessive use, defective
11.
Exit sign(s): required, illumination, photo luminescent
3.
Excessive rubbish, trash, debris
12.
Exit sign lights: obstructed, defective
4.
Fire alarms stem defective
13.
Exit lighting: required, defective
5.
Sprinklers stem: service required, defective
14.
Heating system: defective appliance, flue combustibles
6.
Kitchen hood ext. system: service due
15.
Wiring: exposed, damaged connectors, etc.
7.
Fire walls, ceilings, fire doors, draft stops
16.
Address posted and visible from road
8.
Smoke detectors: required, defective
17.
Other
9.
Fire drill log checked Yes[] No ❑
18.
Other type of inspection - State below
DETAILED EXPLANATION AND CORRECTIONS: CORRECTED:
Date: Discussed with: Signed:
(Print)
n�oNc�,uiiy vnn.c�.
Battalion 1 2 3 4 5 6 7 Station: FPB
By order of the Fire Chief: You are hereby notified to correct all violations immediately or show cause why you should not be
required to do so. A re -inspection will be conducted on . Willful failure to comply with this notice is a
misdemeanor. Violations that are not corrected immediately and/or remain after the re -inspection may be processed as a criminal
offense. Thank you for your assistance and cooperation in minimizing the fire and life loss in our community. (H & S sec. 13112)
White Copy — Station File Yellow Copy — Re-inspect/business Pink Copy — Business 11 Check when sent to prevention
ire Prevention Bureau
76 Nelson Avenue
)roville, CA 95965
telephone 530-538-7888
'ax 530-538-2105
Address:
istant Manager:
1ding Owner:
AMk
Butte County Fire Rescue
California Department of Forestry
and Fire Protection
Facility Inspection Report
White Copy - Business
Yellow Copy — Occupancy File
Pink Copy — Station File
Occ. Class.
Business Name:
Bus: Hm: Fax.
Bus: Hm:
Bus: Hm:
civ nven1Wr9r7niv nr Vn1Tu FACn.1TV RFVF.A1.Fn THE FOLLOWING:
1.
Fire Extinguishers: Required, service due
10.
Exit(s) obstructed, inadequate
2.
Extension cords: Excess use, defective
11.
Exit sign(s) required, illumination
3.
Excessive rubbish, trash, debris
12.
Exit sign lights need replacing
4.
Fire alarm system defective
13.
Exit lighting: Required, defective
5.
Sprinkler system: Service required, defective
14.
Smoke detectors: Required, defective
6.
Kitchen hood extinguishing system service due
15. Wiring: Exposed, damaged connectors, etc.
7.
Fire walls, ceilings, fire doors, draft stops
16.
Heating system: Defective appliance, flue combustibles
8.
Knox Box keys
17.
Address posted and visible from road
9.
Fire Drill Witnessed Yes ❑ No ❑
18.
Other
IDETAILED EXPLANATION AND CUIZKEUHUNS: tVKK_M IVrVI
Date:
Discussed with:
Signed:
0
Inspecting Officer.:, rq 4ac w
Battalion 1 2 3 4 5 6 7 Station: FPB
FIRE PREVENTION SAVES LIVES, PROPERTY, AND BUSINESS. YOUR COOPERATION W
CORRECTING THE ABOVE LISTED ITEMS IS APPRECIATED. RE -INSPECTION DATE:
PI
IV
BUTTE COUNTY FIRE DEPARTMENT/CDF FIRE
TITLE 19/24
FACILITY INSPECTION
INSPECTION NO.6 2 3
REINSPECT: YES L NO
Facilit
Occupancy
Address -
S -j 5'i�'��� �/y
Inspector@✓e1�
` ' "
Phone
2
Station
Contact�&-ice'
'' % -' n"='=
Station Phone
5 :-�f � 3
Compliance: Yes= %
es=_
ACCESS --All inspections
LF ' Address correct/posted and visible from road (Butte Co. Code 32-9)
t..� Access to public street or 20 ft. wide lane (r19-3.05)
41LGates wide enough to admit fire apparatus (T19-3.16)
k'Z;(-' Fire protection equipment visible/accessible (r19-3.14)
RTABLE FIRE EXTINGUISHERS --All Inspections
No = U Not appncaDie = NIA
Extinguishers have current annual service tag (T19 -575.1A)
Maximum travel 75 ft. (r19-567)
Provide clear access to fire extinguisher (T19563.2)
Extinguishers mounted on wall/or in cabinet, visible and signed (r19-563.8)
EXITS --All Inspections
Exits not obstructed Cris -3.11)
,.3�Exit signs in place (CBC 1003.2.9.1)
,,�oors operate without key or special knowledge (CFC 1207.3)
Rooms with Occupant Load of 50 Persons or More
Exit illumination and signs)""ace (CBC 1003 2.82)
Maximum occupancy sign in place (r19-3.30)
Two exit doors/pap/hardware swing in direction of travel (CFC 2501.82)
HOUSEKEEPING -- All Inspections
No waste or rubbish accumulation inside or outside T19-3.14)
Reduce storage to at least "below ceiling/ sprinklers (r19-3.14)
Remove combus. storage from heater, mech., elect. room Cr19-3.19x)
'_Provide approved metal container for oily rag storage (T-15-4,Po)
A:L�Flammable liquids stored properly (T 19-3.15)
f
P
Corrections and Comments
ELECTRICAL --All inspections
r Extension cords do not replace permanent wiring (CEC-400-8(1))
G Extension cords do not pass through doors/walls (CEC-400-8 {2,3))
30 inch clearance around all electrical panels (CEC-110-16A)
All panels and breakers are marked (CEC-110-17 C)
Repair holes in fire -resistive construction CEC (300-21,22)
' Multi -plug power strips have circuit breaker (CEC 400-13)
FIRE PROTECTION EQUIPMENT --All Inspecstions
Hood system serviced/tagged every 6 mo. by cert. tech. (r19 -9o4)
Clean filters, hood, and duct area over cooking appliances (CFC 1006.2.8)
Maintain extinguishing systems (T19-3,14)
Provide spare sprinkler heads (6 pain.) and/or sprinkler wrench (r19-904.5)
Replace damaged, corroded, of painted sprinkler heads (r19-904.5)
Identify sprinkler valves and secure in open position (r19-904.5)
Replace missing caps'on fire department connection Cr19-904.3)
Provide 5 -yr. certification test for sprinkler/standpipe (r19-904)
MECHANICAL EQUIPMENT --All Inspections
_Vents and chimneys -- No obvious hazards (CMC -Ch. 8)
SMOKE DETECTORS -- Day Care Sr. Res., Hospitals, Apts.
Properly installed and tested (T19-749, 754)
SCHOOLS, JAILS AND HOSPITALS
Decorations and curtains fire retardant (T19-3.08)
LPG tanks fenced with locked gates (T19-3.22)
FIRE DRILLS -- School and Day Care (Title 19-3.13)
All systems operable/hooked to office
Held monthly (elementary schools)
Held semi-annually (high schools)
Evacuation plans posted in all rooms
Emergency procedures posted in office
Teachers take roll books
The above deficiencies must be corrected within days.
Owner/Manager
Inspection Date:�Z--
AP #
fice of the State Fire Marshal
INSPECTION REPORT
ct
Tme of Facility: ��✓�� Lt� 'G /A ?TJE��--
of Building:
Title:
Title.
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FIRE CLEARANCE GRANTED T -DATE
STATUS
DEPUTY STATE FIRE DATE OF INSPEC ION
t- C,
-6 (Rev. 7/86)
Pake of
t,srice of the State Fire Marshal
INSPECTION REPORT
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Filj No.:..�::
Na a of Facility:?c-
Name
of Building:
A dress:0,A
FW CIEMWOa atAMM _ T -DATE
.STATUS
OFPUiYST Tf FitE N4ARSiAL DATE OF WECTiON
- 6 (Rev. 7/86)
i ile
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_ ce of the Stale vire Marshal
INSPECO'HON REPORT
Na ie of facility:
Name of Building:
Ad fr ess: _ � !� C�V,,e,- _Z. -N, -c. X 15
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STATE RE MAR
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l)ffice of the State fire Marshal
INSPECTION REPORT
No.:. -QO -04 --23—
OCM—=-QCT-—=�
me of Facility: PEANUT BUTTER PALACE
of Building:
dress: 3524 HICKS LANE
Chico, CA -95926
Discussed with: - - `Cale: .. .
Accompanied by: Peggy Johnson Title:
• n e r n rl, lr,,,
An annual inspection was conducted at the above faclity. No d fi r -i Pari ae were noted-
at
oted-
_ ___
at this time. The facility maintains a reasonable •
Fire clearance i6 granted for one year, -.for 36 amb u1 atory hi 1 dren
FRE cumma Ci vam TOME STATUS
YES •• i. � � :� .�.'...
DEPUTY STATE FRE MAIN - 1 1 OATS OF
-6 (Rev. 7/86)
office of the State Fire Marshal`
- -� REGIONAL
FACILITY FILE CHANGE NOTICE
Name Correction/Change
Address Correction/Change
El Change File Number
El Facility Discontinued
piFFICf
STATE FIRE MA HAL
(P�Ilsue File Number
❑ Other
13 (Rev. 7/86) U,
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NEW
Name:
Name:
Address:
Address: tc.AL5 L -M
City:
city: i Lam•} 0 ��
County:
(No. )
County: (No. }
File No.:.__.. =>
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File No.. _.._ 1� ...._
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13 (Rev. 7/86) U,
jFFICE OF THE STATE FIRE,.YARSHAL
I Williamsburg Lane, Suite 3
Chico, California 95926
916) 895-4312
TSS 459-4312
PLAN REVIEW TRANSMITTAL
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CAUTCOLhU XrATZ FM WURS"AL
DATE: l
OSHPD:
CSFM:i�
AGILITY NAME:
AGILITY ADDRESS:
ROJECT DESCRIPTION:
L/
�c�t Lt._cz-f
s requested, we have reviewed [)Plans []Specifications []Change Order []Addendurn []Instructional Bulletin for the
roject listed above to determine conformance with the fire and life safety standards of Titles 19 and 24, California
ode of Regulations. By copy of this transmittal we are:
advising you that the items listed above were found to be in accordance with the applicable provisions
of Titles 19 and 24.
[] returning the items listed above to you for review. Consideration must be given to all comments noted
in red pencil on the documents.
[) requesting that you contact our office at the telephone number listed above for an appointment for
our stamp of approval or back -check.
othin in our review shall be construed as encompassing structural integrity. Approval of this plan does not authorize
r app ve any omission or deviation from applicable regulations. Final approval is subject to field inspection.
epury Pt!Nt6 Fire Marshal
�c: [] Fire Department
[] Building Department
[] Facility Administrator
[] OSHPD
[] Other
[] Other
[] Other CSFM Regional Office []Coastal []Southern
,#rRield File
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Office of the State Fire Marshal
INSPECTION REPORT
ro.: (40 _ 0 q --7-z":2
Ott, U le b.
of Facility: % L'l t� ?&,Ace
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Na e of Building:
Address:
1(*f"�,
STATE FIRE MA AL
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Office of the State Fire Marsha.
Fire Safety Correction Notice
File No: — - — —
D-9 //iii -
Name:
Address:
The California Health and Safety Code and the State Fire Marshal's regulations require the following fire safety
deficiencies be corrected.
C'_ CJ.
The above deficiencies are to be corrected within days. When ALL deficiencies have been corrected, sign
and return the certification on the opposite side of this form. If you have any questions, contact the Office of the State
Fire Marshal at ( )
ISSUED BY (Deputy State Fire Marshal) RECEIVED BY DATE' -
EN - I I (Rev. 7/86) 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
ame of Facility:����`��
F le No.:
Buildill... Survey
Report (GO -4)
Page 2of2
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• �,. aY.F, ,�`.: ( Q,. � ,lt�s4' . �' �;: i, `P � � ..K.,' -sem, „r<: -
17. Stairs
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18. Ramps
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19. Interior Finish Class
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20. Exits _
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TOTAL WIDTH
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21. Exit Hardware Type
22a. Exit Signs/Mumination
b. Emergency Lighting
23. Auto Sprinkler Coverage
24. Standpipes Class/Location
25. Fire Alarm Type/Coverage
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STliUlG4A 6 mcr�
26. Heating, Ventilation and
Air Conditioning
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27. Electrical installation
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28. Stage/ Platform
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29. Hazardous Areas
30. Other
COMMENTS:
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03-4 (Rev. 7/86)
e I of 2 �` �F��.
(.,rfice of the State Fire Marshal
BUILDING SURVEY REPORT STATE FIRE MA AL
No.: S� - 0't.7 2 �
- (EU -Z:v _ Cces-t�
ne of Facility: V-(g� A���
Name of Building:
Ac dress:
O ner: �r(�-��•1 Jo l�S @-� Telephone No.:
Telephone No.: ()
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1. Occupancy
TYPF J, USE -D ACAPACITY
(2,�i2
2. Construction Type
YEAR BUILT
BASEMENT
t
K)
3. Area (Sq. Ft.)
TOTAL
.r00 0 S G rr
"'LARGEST FLOOR
4. Stories
NO.
-
HEIGHT
HIGH REZ
YES NO
5a. Exterior Wall Construction
� J l �k N c _,� L#'Z �.-
rl4 "t „_. a Y LA
_Z!lr q L co
b. Opening Protection
6. Interior Wall Construction_
Z (� _- .� 7
yj,' S UjAVV
7. Floor Construction
� �.- � 1� � � � J�,.�' `,,, •
8. Roof ConstructionL�b
,_ W
Xz L
o''
-�` 2,t;)1% L. 1.
91 Attic Draft Stops
10a. Occ. Sep. Wall Construction
NO.( I - '�-- 17, 6 w W - X1 .5
b. Opening Protection
02AP.
1 la. Area Sep. Wall Construction
NO.
b. Opening Protection
12a. Smoke Barrier Wall Construction
No.
b. Opening Protection
13a. Corridor Wall Construction
b. Opening Protection
14a. Corridor Ceiling Construction
. -. � � .. r— ... ».• ... .... �—r ..-.. .rr«'A':1 w»J.. ..•-...,
b. Opening Protection
»wC» .n v....._.
.. l i. •'L' . .� ... � 1: i ;'• ' - . �1 - � � .. '
15a. Shafts
NO.
TYPE
b. Opening Protection
16a. Stair Enclosure
NO.
b. Opening Protection
-
GO -4 (Rev. 7/86)
ljl�
ws
File
rr
L .e of the State Fire Marshal
FACILITY BUILDING RECORD
rQ 2 LO-7-Lo�o
Facilty, Name: �(�-���ti� -9�A'1-4'YA"
Add ess: �`-��� (-F-t (�.{�`� (�►�,l�j �
A Qi�l`Z-C-j
dFF�cEq'
C
STATE FIRE MA AL
r,. BUILDING
F
SFM
No.
FACILITY.
BUILDING
No.
� � : � . � � • _ ' : ' .:. ; : r �-
Y
' f
BUILDING NAME i !:
�
T 2
OCCUPANCY
CLASSIFICATIONCie
.� ,._:....
Flu
r
� •.
�
Wy i �1rY7Vt1 fl�L 1.• � !� < 2 n.i? t .:�-.; r. .�. �. a '> i .i. 'i {.A .�'' •'.d <I:;ZF 4. t'S .� 1 i..
. e , •t: '� 1. �. .. �ri; � .::tit ...- ..r t .>•. < . >. � �''i e.: <`Y'i� d -rd
.'I. � / � �.. � � A �<.;.Ar .� w. - ;�' �'. t:�.� .F �. ��. f if.'i[ }�. �.. 7. .t ��.: .�5'
, - 3•? - .t; - -.': t ) {': �" ; i""l'V a . J {: j, t{:..�..a, ..<.. .T'<{ •.1� �,r.vr t`' 7�s_y, �': '''3. >. ,� tt.£i'
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M -"[Rev. 7/86j
'e of
.(9-4 '!?
No.: j)�2, �1--l-'O"
...ffice of the State Fire Marshal
REINSPECTION REPORT
of Facility: : ?�C.NW r 2 7--- 1L'Z1`� � O\LAC4:''-
ie
of Building:
rens: ses
CNL Lo Olt
0'fKE
t
t �
y
STATE FIRE MA SHAL
C►iscvssed with:4 A
ccotnpar;ied byr �.
ItX
Fire Safety Deficiencies Numbered noted on the Letter ❑
Fire Safety Correction Notice (EN -11) El dated ' L 'D have been corrected.
Uncorrected Deficiencies Numbered were re -issued as shown
on the Fire Safety Correction. Notice dated 2Cto , which is attached to and made aart of this Report.
P Po
In addition, new deficiencies were identified at the time of this reinspection, and are shown as Items
on the attached Fire Safety Correction Notice.
Fire Clearance Instructions:
Office of the State Fire Marshai
Fire Safety Correction Notice
n^
File No:`Jim' - — —
7 - -
Name: �= `jua` • e: i _
Address:
The California Health and Safety Code and the State
deficiencies be corrected;
Fire` Marshal's regulations
require the following fire safety
c c
The above above deficiencies are to be corrected within --- days. When ALL deficiencies have been corrected, sign
and return'the certification on the opposite side, of this form. if you have any questions, contact the Office of the State
Fire Marshal at ( )
ISSUED BY (Deputy State Fire Marshal RECEIVED BY DATE -
EN -11 (Rev. 7/86) - 86 96708 DISTRIBUTION: GREEN—Facility WHITE—Region YELLOW—Field
STAT FIRE MARSHAL CIDPY DISTRIBUTION:
SEE REVERSE OF COPIES 2 AND 5 FOR
FIRE SAFETY INSPECTION REQU, 1 -3 -STATE FIRE MARSHAL
INSTRUCTIONS FOR COMPLETION
2 -FIRE AUTHORITY
STD 8 0 (REV. 8 / 86)
1. REQUEST DATE 2. PROGRAM
4 -5 -LICENSING AGENCY
7-10-90
3. AGEF; CONTACT 4. TELEPHONE NO. S. EVALUATOR
DS /COMMUNITY CARE LICENSING (916) 895-5033 0111-BAKKE
S. SFM REGION 7. SFM I.D. NO. S. REQUESTING AGENCY FACILITY NO.
9. REQUEST CODE
NEW APPLICATION 041373101
1-A
CODES
RESPONSE REQUIRED
1. ORIGINAL A. FIRE CLEARANCE
2. RENEWAL B. LIFE SAFETY
3. CAPACITY CHANGE
10. AG CY MPARTMETOT OF SOCIAL H�CIRS..
4. OWNERSHIP CHANGE
NAN E CURMMITY CARE LI CENS IR(G
S. ADDRESS CHANGE
AND ciao Cohas s e t Ro ad o Suite 8
S. NAME CHANGE
PREVIOUS NAME
ADDRESS L M1009 OA 86926
7. OTHER
DATE OF ORIGINAL REQ.
11. AM LATORY NONAMBULATORY
TOTAL CAP.
DATE OF LAST FIRE CLEARANCE
CAPACITY AGE RANGE (YEARS) PREVIOUS CAPACITY AGE RANGE (YEARS) PREVIOUS
TO 16 19 TO 65 AND CAPACITY CAPACITY
TO 16 19 TO 65 AND
36 111 65 OVER 0 65 OVER,
36
19. FACILITY
CODE 850
12. FALITY NAME
13. NO. BLDGS
PEC N'UT BUTTER PALACE
1
CODES
1. GACH
14. STR ET ADDRESS (ACTUAL LOCATION) P.O. BOX
15. RESTRAINT
7. ICF/OT
2. GACH/R 8. ICF/DD
35'44 HICKS LANE
NONE
3. SH 9. ADHC
CITY ZIP CODE
16. HOURS
4. APH 10. CLINIC
C H C O C A 95926
DAYS
5. PHF 11. JAIL
17. FAC ITY CONTACT PERSON TELEPHONE NO.
16A. SPECIAL
6. SNF 12. ICF /DDN
JO NISON9 PEGGY D. 1(916) 894-2866
1
CCC 13. OTHER
TO BE COMPLETED BY
INSPECTING AUTHORITY
16. FIRE
�
26. CLEARANCE
CODE
AUTHOR STATE FIRE MARSHAL
NAME JACK P I R I S K Y
CODES
AND 4 W I L L I A M S B E R G LANE, # 3
1. FIRE CLEAR, GRANTED
ADD Ess L CHIC 0, CA 95926
2. FIRE CLEAR, DENIED
3. FIRE CLEAR, WITHHELD
27. DENIAL
CODE
TO BE COMPLETED BY INSPECTING AUTHORITY
CODES
21. INSPECTOR'S NAME 3AL PHONE NO. 22. CFIRS
'
23. T-19 OCC.
ID NO.
-r" S�
CLASS
1. EXITS
l.J ✓
2. CONSTRUCTION
24.1 SP. TE 25. NS�ECTO IG ATUR�
t
3. FIRE ALARM
4. SPRINKLERS
26. EXIDL IN)DENIAL OR LIST SPEC L CONDITIO S
5. HOUSEKEEPING
(�---KAPI
I6.
SPECIAL HAZARD
7. OTHER
STATE FIRE MARSHAL USE ONLY
(- W-PARTMEr1T OF SOCIAL 90MCES
20. REGION.
COWM I TY CARE LICENSING
OFFIC E
520 Cohasset Road, Shite 8
AND
Chico, OA 95926
ADDRESS
I
J
'age -of- ; ffice of the State Fire Marshal
REINSPECTION REPORT
Fie No.:.��—�
N me of Facility: .
Name of Building:
Address:
uL5 l�l�n�C�
scLessyed with .�a, b
Accompanied by
•
�FKt
STATE FIRE MA SHAL
ire Safety Deficiencies Numbered noted on the Letter ❑
ire Safety Correction Notice (EN -11) El dated have been corrected.
)ncorrected Deficiencies Numbered were re -issued as shown
►n the Fire Safety Correction. Notice dated , which is attached to and made a part of this Report.
addition, new deficiencies were identified at the time of this reinspection, and are shown as Items
on the attached Fire Safety Correction Notice.
e Clearance Instructions:
ENMTATE C STATUS
STATE DATE CWF im
co • s (R�• 7/86)