TRI STATE FIRE PROTECTION, LLC BILL TO: SHIP TO:
Gilford, Lancaster, Nashua, Hudson & Newington, NH Telephone: (603) 293-7531 Fax: (603) 589-2051 www.getfireprotection.com
Remit to: 26 Hampshire Drive Hudson, NH 03051
WORK ORDER #: 10948254
BILL TO:
SHIP TO:
NH
NH
Contact: Phone: 772-3389
PART
PORTABLES
PART
DESCRIPTION
PART
DESCRITPTION
2010
FX Service Call Monthly Fire Ext Inspection
3010
2019
FX Disposal Conductivity Test CO2 Fire Ext
4004
Fire Ext Labor Hours
3006
2012
Weatherprf Tyvek Tags/Cvrs
3061
2015
Hang/Relocate FX
3062
Hydrotest SCBA/SCUBA cyl Hydrotest Stored Pressure FX Hydrotest CO2 (up to 20 lbs) Hydrotest Cl Ag FX up to 5 lbs Hydrotest Cl Ag FX up to 20lbs
3011
2009 .
STRATHAM COMMUNITY CHURCH
STRATHAM
03885
Phone: Email: CUST. PO#
CUSTOMER ID:
6 EMERY LN
C/O SUE HUNTER/TREAS., PO BOX 143
QTY
Page 1 of 2 Inspected to the current version of NFPA 10
DATE: 4/22/2016
STRATHAM COMMUNITY CHURCH
STRATHAM
PORTABLE FIRE EXTINGUISHER INSPECTION REPORT
TRI STATE FIRE PROTECTION, LLC
QTY
3003
Misc Parts
4006
Shop Labor
4009
FX Gauge
Hydrotest Fire Hose
4015
Fire Ext Pull Pin
3041
Swap-out – Dry Chem/CO2
4016
CO2 FX Safety Relief Device
3042
Swap-out K Class/Clean Agent
3067
Visual Eddy Test
3043
Swap-out Parts
5009
FX Labels
1025
New 2.5lb D/C Fire EXT
5035
FX Cabinets
1050
New 5lb D/C Fire EXT
1010
New 10lb D/C Fire EXT
NO
EMERGENCY LIGHTS E-Light/Exit Sign Inspection Check condition of Exit Lights and Fire Extinguishers Verify proper light coverage Verify Charge Light Indicator Working Check condition of Batteries Verify batteries are charging Perform required load test Check Illumination of lamps/heads Check location and condition of remote heads Check Illumination of remote heads
3019 3020
Recharge 10lb CO2 FX
1020
New 20lb D/C Fire EXT
3021
Recharge 15lb CO2 FX
1105
New 5lb CO2 Fire EXT
3022
Recharge 20lb CO2 FX
1110
New 10lb CO2 Fire EXT
3024
Recharge Clean Agent FX___lbs Recharge Class K Fire EXT
1115
New 15lb CO2 Fire EXT
1425
New 2.5GAL APW Fire EXT
3029
Recharge water mist FX
1525
New 6.0 L Class K Fire EXT
5007
Fire Extinguisher Sign
1530
New 1.75GAL Water Mist
5008
Fire Ext Stand out Sign
1305
New 5lb Clean Agent FX
5010
Fire Ext Wall bracket
1311
New 9lb Clean Agent FX
2007
Fire hose service/ rerack
1315
New 13lb Clean Agent FX
3060 3014 3015 3016 3017
3026
4002 4000
6yr Maint Dry Chem Fire Ext 6yr Maint Cl Ag FX up to 5lb Recharge 2.5lb Dry Chem FX Recharge 5lb Dry Chem FX Recharge 10lb Dry Chem FX Recharge 20lb Dry Chem FX Recharge 5lb CO2 FX
3002
QTY
YES
Gilford, Lancaster, Hudson, Nashua & Newington, NH Telephone: (603) 293-7531 Fax: (603) 589-2051 www.getfireprotection.com
TRI STATE FIRE PROTECTION, LLC Remit to: 26 Hampshire Drive Hudson, NH 03051
PORTABLE FIRE EXTINGUISHER INSPECTION REPORT Page 2 of 2 Inspected to the current version of NFPA 10
WORK ORDER #: 10948254 COMMENTS:
QTY
PART
DESCRIPTION
PRICE
2001 2003 2004
FIRE EXT SERVICE CALL FIRE EXT ANNUAL INSP. PER UNIT-INC. TAGS & TAMPERS DISCHARGE ASSURANCE PLAN (12 MONTHS)
3050
FIRE EXTINGUISHER CLASSROOM TRAINING (UP TO 20 PEOPLE)
52 1
4007 6002 6048
FIRE EXTINGUISHER VALVE STEM REPLACED EMERGENCY LIGHT INSPECTIONS
5
6080
6v 5amp Battery
5
6099
Battery removal hazmat
AMOUNT
Emergency light service call
Customer declines annual functional testing of emergency light systems as required by NFPA 101 (check here):
SUB TOTAL TAX TOTAL
THIS IS NOT AN INVOICE 4/22/16
CUSTOMER’S SIGNATURE - DATE Jolynn Wilson
CUSTOMER’S PRINTED NAME
BILLING ADDRESS CONFIRMED
4/22/16
TECHNICIAN’S SIGNATURE – DATE
Remit to: 26 Hampshire Drive Hudson, NH 03051
WORK ORDER #: 10948254
BILL TO:
SHIP TO:
NH
NH
Contact: Phone: 772-3389
PART
PORTABLES
PART
DESCRIPTION
PART
DESCRITPTION
2010
FX Service Call Monthly Fire Ext Inspection
3010
2019
FX Disposal Conductivity Test CO2 Fire Ext
4004
Fire Ext Labor Hours
3006
2012
Weatherprf Tyvek Tags/Cvrs
3061
2015
Hang/Relocate FX
3062
Hydrotest SCBA/SCUBA cyl Hydrotest Stored Pressure FX Hydrotest CO2 (up to 20 lbs) Hydrotest Cl Ag FX up to 5 lbs Hydrotest Cl Ag FX up to 20lbs
3011
2009 .
STRATHAM COMMUNITY CHURCH
STRATHAM
03885
Phone: Email: CUST. PO#
CUSTOMER ID:
6 EMERY LN
C/O SUE HUNTER/TREAS., PO BOX 143
QTY
Page 1 of 2 Inspected to the current version of NFPA 10
DATE: 4/22/2016
STRATHAM COMMUNITY CHURCH
STRATHAM
PORTABLE FIRE EXTINGUISHER INSPECTION REPORT
TRI STATE FIRE PROTECTION, LLC
QTY
3003
Misc Parts
4006
Shop Labor
4009
FX Gauge
Hydrotest Fire Hose
4015
Fire Ext Pull Pin
3041
Swap-out – Dry Chem/CO2
4016
CO2 FX Safety Relief Device
3042
Swap-out K Class/Clean Agent
3067
Visual Eddy Test
3043
Swap-out Parts
5009
FX Labels
1025
New 2.5lb D/C Fire EXT
5035
FX Cabinets
1050
New 5lb D/C Fire EXT
1010
New 10lb D/C Fire EXT
NO
EMERGENCY LIGHTS E-Light/Exit Sign Inspection Check condition of Exit Lights and Fire Extinguishers Verify proper light coverage Verify Charge Light Indicator Working Check condition of Batteries Verify batteries are charging Perform required load test Check Illumination of lamps/heads Check location and condition of remote heads Check Illumination of remote heads
3019 3020
Recharge 10lb CO2 FX
1020
New 20lb D/C Fire EXT
3021
Recharge 15lb CO2 FX
1105
New 5lb CO2 Fire EXT
3022
Recharge 20lb CO2 FX
1110
New 10lb CO2 Fire EXT
3024
Recharge Clean Agent FX___lbs Recharge Class K Fire EXT
1115
New 15lb CO2 Fire EXT
1425
New 2.5GAL APW Fire EXT
3029
Recharge water mist FX
1525
New 6.0 L Class K Fire EXT
5007
Fire Extinguisher Sign
1530
New 1.75GAL Water Mist
5008
Fire Ext Stand out Sign
1305
New 5lb Clean Agent FX
5010
Fire Ext Wall bracket
1311
New 9lb Clean Agent FX
2007
Fire hose service/ rerack
1315
New 13lb Clean Agent FX
3060 3014 3015 3016 3017
3026
4002 4000
6yr Maint Dry Chem Fire Ext 6yr Maint Cl Ag FX up to 5lb Recharge 2.5lb Dry Chem FX Recharge 5lb Dry Chem FX Recharge 10lb Dry Chem FX Recharge 20lb Dry Chem FX Recharge 5lb CO2 FX
3002
QTY
YES
Gilford, Lancaster, Hudson, Nashua & Newington, NH Telephone: (603) 293-7531 Fax: (603) 589-2051 www.getfireprotection.com
TRI STATE FIRE PROTECTION, LLC Remit to: 26 Hampshire Drive Hudson, NH 03051
PORTABLE FIRE EXTINGUISHER INSPECTION REPORT Page 2 of 2 Inspected to the current version of NFPA 10
WORK ORDER #: 10948254 COMMENTS:
QTY
PART
DESCRIPTION
PRICE
2001 2003 2004
FIRE EXT SERVICE CALL FIRE EXT ANNUAL INSP. PER UNIT-INC. TAGS & TAMPERS DISCHARGE ASSURANCE PLAN (12 MONTHS)
3050
FIRE EXTINGUISHER CLASSROOM TRAINING (UP TO 20 PEOPLE)
52 1
4007 6002 6048
FIRE EXTINGUISHER VALVE STEM REPLACED EMERGENCY LIGHT INSPECTIONS
5
6080
6v 5amp Battery
5
6099
Battery removal hazmat
AMOUNT
Emergency light service call
Customer declines annual functional testing of emergency light systems as required by NFPA 101 (check here):
SUB TOTAL TAX TOTAL
THIS IS NOT AN INVOICE 4/22/16
CUSTOMER’S SIGNATURE - DATE Jolynn Wilson
CUSTOMER’S PRINTED NAME
BILLING ADDRESS CONFIRMED
4/22/16
TECHNICIAN’S SIGNATURE – DATE
