22515 HWY 99 (2)SNOHOMISH CO.
lot
8
Serving Brier, Edmonds, and 12425 Mer idian Ave S
Mo untlake Terrace Everett, WA 98208
Phone (425) 551-1200
www.FireDistrictl. org Fax (425) 551-1272
FIRE PREVENTION,,,
INSPECTION REPORt,',.'!'
0 EDMONDS
-OBRIER
[I MOUNTLAKE TERRACE
[3 UNINCORPORATED
r FREQUENCY
STATION & S IFT
LOCATION:
.22515 Highway 99 98026
Annual
20-A
BUSINESS NAM&
PHONE:
SCHEDULED
Rite Aid Drug Store
42567019.18
DATE DUE I' Apr 2016
MAILING
UFIR 110
583
ADDRESS:
22515 Highway 99, Edmonds, WA 98026
BUSINESS OWNER:
HOME PHONE:
Ackley, Billie
EMERGENCY-1:
HOME PHONE:
CURRENT
KEY ACCESS-2:
Kupriyanov,Jay
HOME PHONE:
4257370279
CITY YES NO
BUSINESS F
EMAIL:
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
FIRE SYSTEMS: AS'1A6 FA 7/15 FE 6/15 FD Lk Box
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS
1st RE -INSPECTION 2nd RE -INSPECTION 'QFE ENSION FINAL RE -INSPECTION
VIOLATIONS
DATE DUE: DATE DUE: ANTED TO: DATE DUE- CITED:
PERSON PERSON P . ERSON
CONTACTED: CONTACTED:
CONTACTED:
INSPECTOR: I pi �;11 rj INSPECTOR.
IINSPECTOR,
DATE: DATE: DATE, 3
v6EkidNs VIOLATIONS:,, OfATION ISS01f6
15 PRE -CITATION 4
5 L EPSENT -NUMBER:
CODE
2 6 2 16 DATE:
SECTION:
RETURN RECEIPT
3 7 RECEIVED r,
DISPOSITION:
18 4 DATE, 7
8
LETTER NEEDED YES NO
LETTER NEEDED YES NO
Emerald Tire
Fire Spfinkler Specialists
11021 Cramer Rd.KPN - Gig HarborWA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
-2- Zpa ) rYl -1
Occ n c y?A d dde FNffXccupancy NNNQ
Responsible Person: Phone NU54�
Building Owner:
Date of Inspection; Type of Inspection:
Testers Name (Please Print): Fne'�5
Phone Number-
A171 Aq
Quarterly F] Annua �z Other []
WA State FSCC#
Trip test ((rLt(3ior full flow) conducted: .................................................. Yes,�5hlo E]
Systemtrippedin '�15 seconds.
2. All flow switches, supervi sory switches and alarm bells tested: ..................... Ye5a- No E3 N/A E]
3. Alarm bell operates: ............................................................................. YesET�No F1 N/A 0
4.
Flow tests conducted: ...........................................................................
Flow pressure: 0� A —psi 2-inchdrain? .......................................
YesEr-No E] '�)
Yes E] No,2-
5.
Systems inspected and lubricated: ..........................................................
Yes4;-rNo 11
N/A El
6.
Air compressor refills system in 30 minutes: .......... ... .................................
Yes.ET--No r-1
7.
System drained and restored to normal operation: .....................................
Yese"No El
8.
Were the heat actuation devices tested on pre -action and deluge system? .....
Yes E] No F�
ET SYSTE NR-f-REEZr3_)_Y_S�T. �Tested at
�npest conclucted... .................................. ..........
11711
0
Yese7--No F]
Static pressure: psi Flow pressure: i in"*? .......
Ye&Q-,No [-]
N/A L]
2.
Flow switches, supervisory switches and alarm bells tested: .....................
Yes��o E]
N/A (]
3.
Alarm bell operates: ................... .........................................................
Yes.Er-No El
N/A El
4.
Systems inspected and lubricated: ..........................................................
Yesi�o�
5.
Pressure regulating valves tested . ............................................... ...........
Yes[] No []
N/4��
. .1 5
AUTOMATIC SPRINKLER SYSTEMS konti6ued)
General:
1 . Central Station Monitoring? .......................................................................... YesE] NoR
Monitoring company name
2. Location of Sprinklers
100% ......... �� Parking .... Basement ......... E] Hal , ways ......... Other ........ 0
3. Pumper connections and clapper valves unobstructed ....................................... Yeq�T� No
4. Sprinkler heads less than 50 years old ............................................................. YejEr Non
S. Spr[nkler coverage is acceptable .................................................................... Yes.0' No El
6. Spare sprinkler heads are available ................................................................. Ye&f�r No F1
7. Systems left in service .................................................................................. YesC' No
8. Valves are sealed or supervised ...................................................................... YesE�-' No
9. Signs are provided on valves ................... ...................................................... Ye%O'No n
10. City static water pressure psi.
Problems Found:
0 lyk�')-n �YOu�
yl;MK� 11o'cly, �-Wv— - �7ax' �s
Corrections Made: Date Corrected: Corrected By;
SIGNATURE OF TESTER: — !9�� �Ib ZZ cz, �-
AGENCY. Emerald Fire PHONE, 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN. Gig Harbor, WA 98329
I'Emerald
ire
Fire Sprinkler Specialists
11021 Cramer Rd.KPN - Gig HarborWA98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
r t�)
-2-0 1�a 45y A d d as s: 1 �97 �-r t �_s VVA - �99 3 0 u p a n , Tya"' m e.,— �-�)
u �Nb
Responsible Person: Phone N e
Building Owner- Phone Number:
Date of Inspection: 7Z 2 / 1_--_1 Type of Inspection: Quarterl Annual F-1 Other E]
I y/
Testers Name (Please Print): 5-5 WA State FSCC#
) 1700
bRYSYS:T:Ek�p���� Quo�t-e<V vs-swLk
I Trip test (dry trip or full flow) conducted: .......................................... N//.$-YesE1 NoEl
System tripped in Y, seconds.
2. All flow switches, supervisory switches and alarm bells tested: ..................... Yes F� No El N/AE�'
3. Alarm bell operates: ............................................................................. Yes 0 No F1 N/Aa-�"
4. Flow tests conducted- -V S El
Flow pressure: ........................................................... )+Ye No EJ
psi 2-inch drain? ....................................... Ye sK No F-�
11 —
5. Systems inspected and4ub4eate4 . ......................................................... Ye 5Z No El N/A n
6. Air compressor refills system in 30 minutes: ...................................... SIA Yes F71 No F-1
7. System drained and restored to normal operation: ..................... ........ W
A -Yes f_� No Fl
8. Were the heat actuation devices tested on pre -action and deluge system? ..... Yes El No F� N//
�ET �SYSTE�MA ����Testecl at
I Trip test conducted: ................................ KAYesO No[-]
Static pressu I re: psi Flow pressure: si 2 inch drain? ....... Ye,��Ioll N/AF-1
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes El No F-1 N/A_,F:
.�r
3. Alarm bell operates: ............................................................................. Yes F] No 7 N/AffT-
4. Systems inspected and-l.�� .......................................................... Yes,�No 0
5. Pressure regulating valves tested: ........................................................... Yes E] No E] N/
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
I
Central Station Monitoring? ............. .. .............. ...... N. .....................
Yes
No F-1
Monitoring company name
2.
Location of Sprinklers
100% ......... / Parking ......... Basement ......... F-1 Hallways ......... E] Other...
3.
Pumper connections and clapper valves unobstructed .......................................
yes/
Non
4.
Sprinkler heads less than 50 years old .............................................................
Yeso
Non
5.
Sprinkler coverage is acceptable ....................................................................
YesZf
No F-1
6.
Spare sprinkler heads are available ...............................................................
Yes)6
Non
7.
Systems left in service ..................................................................................
Y S
e Z
Non
8.
Valves are sealed or supervised ......................................................................
YesZ
Non
9.
Signs are provided on valves .........................................................................
Ye /s
Non
10.
City static water pressure psi. z z
ProbleM5 Found:
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OFTESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN, Gig Harbor. WA98329
SetVing Brie';: Edmonds, ai
f4ww.FireDistrictj.org
I RE Mountlake Terrace
DISTR. T
LOCATION: 22515 Highwa y 99 98026
BUSINESS NAME: Rite Aid Drug Store
MAILING
ADDRESS: 22515 Highway 99, Edmonds, WA 98026
BUSINESS OWNER: Ackley, Billie
EMERGENCY-1. Rite Aid
KEY ACCESS-2: CA V,�A (7,1 V). 0
EMAIL: �hn
PERSON CONTACTED:
NAME OF INSPECTOR: F� +Z-�CjC1y_ 0��
FIRE SYSTEMS: AS 1/15 FA 7/14 FE W14 FD Lk Bo;7—
i/5
id
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4256701918
HOME PHONE:
HOME PHONE: 115- 131
HOME PHONE- D
"I � .(Oivl C)2.-Jq
FIRE PREVENTION
19SPECTION REPORT
WDMONDS
El BRIER
El MOUNTLAKE TERRACE
[I UNINCORPORATED
" FREQUENCY I STATION & SHIF'_*�
Annual 20-D
SCHEDULED�kpr 2015
DATE DUE
LIFIR 1,,583
CURRENT
CITY NO
BUSINESS
LICENSE Z��o
INITIAL IYSPECTIPN DATE
AP D/ 5
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
7/
4
5
5
6
1 -'6
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
1st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE.,
EXTENSION
GRANTEDTO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
'PERSON
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:----
4
2
6
2
6
DATE:
CODE
SECTION:
5
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
8
4
8
DATE:
DISPOSITION:
LETTER NEEDED [-] YES No
LETTER NEEDED Ej YES [:1 NO
8
FIRE DEPARTMENT COPY
Emerald Pire
Fire spfinkler Specialists
11021 Cramer Rd. KPN - Gig Harbor, WA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
F���s \M c�O2�>
O��&a1n% A� Occupa N 5h
'S
Responsible Person: Phonewwr >
Building Owner: Phone Number:
Date of Inspection: Type of Inspection: Quarterly F� Annual Other
Testers Name (Please Print): 5f I A y1e__- T::�O WA State FSCC#
1 Triptest(� ALtrip rfullf] Mconducted: ................................................ .. YesZ No
System tripped in J) 6 seconds.
2. All flow switches, supervisory switches and alarm bells tested: .....................
Yes/
No F�
N/A F1
3. Alarm bell operates: .............................................................................
YesZ
NoF�
N/AF�
4. Flow tests conducted: ........................................................................... YesZ No E]
Flow pressure: 10 psi 2-inchdrain? ....................................... ME] Nqg-
5. Systems inspected and lubricated: .......................................................... Ye S
0 No F� N/A E]
6. Air compressor refills system in 30 minutes: .............................................. yez No Fl
7.
System drained and restored to normal operation: .....................................
Yes 171 No r-�
8.
Were the heat actuation devices tested on pre -action and deluge system? .....
Yes El No El
N/&��
(WET SY�S�T�EA*T+f RK-zE5Y51TM---7es_ted at
1.
rip test conduct d ................................... ...............
Static pressure: Tm psi Flow pressure: si 2 inch drain? .......
YeS4� No 0
Ye;�o E]
N/A F�
2.
Flow switches, supervisory switches and alarm bells tested: .....................
YesE"o Ej
N/A F-�
3.
Alarm bell operates: .............................................................................
Yekf� No Fl
N/A F
4.
Systems inspected and lubricated: ..........................................................
Yes'f� No M
5.
Pressure regulating valves tested: ...........................................................
Yes Ej No[:]
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
1. Central Station Monitoring? .............. ........................................................ Ye?K No
Monitoring company name
2. Location of Sprinklers
13&
100% ........ Parking ......... El Basement ......... Hallways ......... Other .........
3. Pumper connections and clapper valves unobstructed ....................................... yes/" No
4. Sprinkler heads less than 50 years old ....................... ..................................... Yes No
5. Sprinkler coverage is acceptable .................................................................... Yes�� No F�
6. Spare sprinkler heads are available ................................................................. Yes� Non
7. Systems left in service .................................................................................. Yes No F1
8. Valves are sealed or supervised ...................................................................... Ye NoR
9. Signs are provided on valves ....................... ...... Yes/ No [:1
10. City static water pressure PSI.
Problems Found:
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILINGADDRESS: 11021 Cramer Road KPN,Giiz Harbor, WA98329
EMERALDERE, LLC
�i Fire Sprinkler Specialists
4, 11021 Cramer Road KPN, Gig Harbor, Washington 98329
Ph (253) 857-2056 — Fax (253) 857-2312
SYSTEM CORRECTION REPORT
Date ( FPB File #
System Type:
Alarm /Sprinlcler —Rangehood Standpipe Fire Escape Other
Name of Facility: _L�& 4a A'I 4 �5-1 a-3 --Contact Person: Mr, j, ,
Address: 2. . J_ Phone:
Have your service provider complete section below and return to this office within 7 days of
completion:
Date Corrections Made:
Company Making Corrections: Emerald Fire
Company Contact Persorl: Bob Pactay 253-857-2056
Phone.
Corrections Made:
On I
Of Technician
Signat re
x
. Emerald
Pire
�7 Fire ~�pr"^""^"~'r ~�p~'^^~°""~^ts
ll03lCramer Rd.KPN ^ Gig HarborVVA98329
Office (2S])857-J056 ^ Fax (253)857-2]12 ^ Local 899Contractor
AUTOMATIC SPRINKLER �����1F����
�n�� n��x�o��x n~~ .�x ono"�nxu~u~nu SYSTEMS
.� u u�vvu_v
(OS�f Report)
�^�vww--'Occupancy Address: A tA A OJA Occupancy Name: A rc�
Building Owner: Phone Number:
Date of Inspection: Type of Inspection: Quarterly I/ Annual F-1 Other F�
Testers Name (Please Print): WA State FSCC#
DRY SYSTEM/PRE-ACTION SYSTEM:
Trip l
Ye5F]
NO
l. test (dry trip Ucted:.^..^^.....^.....................
Systerntrippeclin 1114A seconds.
2. AUflovvsvvi��he� supervisory alarmb�Ustested� .—._.............
Yes
�
No
N/AE]
3. Alarm bell operates: .—.------------..—......--...
Yes
No Fl
N/A2
4. Flow tests conducted: ............................................................................
Yes EJ
No
Flow pressure: V 11A psi 2-inchdrain? .......................................
Yes E-1
No��'
5. Systems inspected and |ubhcated:----.--------.------..
���
Yes ��
Non
N/AFl
6. Air compressor refills system in]Ominutes: ..............................................
Yes
No
�/�i
^*
7. System drained and restored tonormal operation: .....................................
Yes
No El
.�
AyvA
8. Were the heat actuation devices tested on pre -action and deluge system? .....
Yes E]
No E]
N/A Nr/
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested af
1 Trip test conducted:YesO NoFl
Static pressure: _psi Flo 2inch drain? ....... Ye5El No
V- N/A
I F|ov9witche�supervisorysv�hex@ d4b�)Ist�d�---.---. Yes No�lN/�Fll ^�
zL Systems inspected and lubricated: ........................................................ Ye5Fl NOF�
5. Pressure regulating valves teste.0 ...................................... .................... Yes E] No[] N/AR
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
1. Central Station Monitoring? .......................................................................... Yes V No
Monitoring company name
2. Location of Sprinklers
100% ......... F-1 Parking ......... R Basement ......... E] Hallways ......... Other ........ EK/
3. Pumper connections and clapper valves unobstructed ....................................... yes[V NoR
4. Sprinkler heads less than 50 years old ............................................................. Yes d No R
5. Sprinkler coverage is acceptable .................................................................... Yes I/ NoR
6. Spare sprinkler heads are available ................................................................. Yes T� NoR
7. Systems left in service .................................................................................. Yes i NoR
8. Valves are sealed or supervised .................... .................................................. Yes Ei( NoR
9. Signs are provided on valves ......................................................................... Yes 5/No R
10. City static water pressure 2,�r psi.
Problems Found:
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER:_
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILING ADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
i
Emerald Pire
Fire Sprinkler Specialists
11021 Cramer Rd.KPN - Gig HarborWA98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
=L�
I EfC1
Occupancy Address:
s [,6Z a& - 02IR Occupancy Name" d"� It'S183
Responsible Person:,
Phone Number:
Building Owner: Phone Number:
Date of Inspection: Type of Inspection: Quarterly Y Annual E] Other F]
Testers Name (Please Print): 'FS� S�X_a� WA State FS'CC#
�j I
DRY SYSTEM/1PRE-ACTION SYSTEM:
1 Trip test (dry trip or full flow) conducted: .... ............................................. Yes No E]
System tripped in seconds.
2. All flow switches, supervisoryAitches a, /dalarm bells,1ted.: .............. ... Yes No E] N/A E]
3. Alarm bell operates: ........ Yes Ej Noo N/A E]
./ U . ............. ......................................
4. Flow tests conducted: ..... .. .................. ............... .............................. Yes E] No E_]
Flow pressure: psi 2-in drain? ......... .............................. Yes E] No E]
5. Systems inspected and lubricated: ......................... .. ............................ Yes El No [I N/A E]
ed
p
2
n
*d'
ra
i
n
and b /cated ...
lu ri . . .... .. ....
6. Air compressor refills system i 0 minutes: ............ ................................. Yes f-1 Non
1
7. System drained and resto d to normal operation: ..................................... Yes El No 0
8. Were the heat actu *on devices tested on pre -action and deluge system? ..... Yes E] No E] N/A
WET SYSTEM/ANTI-FREEZE SYSTEM: Tested at
1 Trip test conducted: .............................................................................. YesE] Nov
Staticpressure: I/<- psi Flow pressure: psi 2 inch drain? ....... YesEl NoE] N/AR(
2. Flow switches, supervisory switches and alarm bells tested: ..................... YesEj NoE�/N/AE]
3. Alarm bell operates: ....................... I ..................................................... Yes Ej No E] N/A V
4. Systems inspected and lubricated: .......................................................... Yes 2' No 0
5. Pressure regulating valves tested: ............................................................ Yes E] No Ej N/A
AUTOMATIC SPRINKLER SYSTEMS (continued)
General:
1. Central Station Monitoring? .......................................................................... Yes 12( No R
Monitoring company name
2. Location of Sprinklers
100% ......... E/ Parking ......... 0 Basement ......... El Hallways ......... 0
3. Pumper connections and clapper valves unobstructed ....................................... Yes No Ej
4. Sprinkler heads less than 50 years old ............................................................. Yes No R
5 , Sprinkler coverage is acceptable .................................................................... Yes NoR
6. Spare sprinkler heads are available ................................................................. Yes 19/ NoR
7. Systems left in service .................................................................................. Yes 1W NoR
8. Valves are sealed or supervised ...................................................................... Yes V NoR
9-. Signs are provided on valves ......................................................................... Yes [j/No,
10. City static water pressure I i psi.
Problems Found:
'a 401 C" 6/A Z�fk— 1EAC1'%V15 OV%- %Scjes F�61
Corrections Made: Date Corrected: Corrected By:
SIGNATURE OF TESTER: -4��
AGENCY: Emerald Fire tl PHONE: 253-857-2056
MAILING ADDRESS: 11021 Cramer Road KPN, Gig Harbor, WA 98329
Deficiency Repair Worksheet
Complete this sheet if deficiencies are noted on the sprinkler inspection report.
5-'."dd9 F-icv, —
(Company)
5530
Vendor ID#
Rote Aid #5183
Location
Z'j'Q 't�&QOL':�
(Prepdred by)
1125634
(WO #)
(Inspection Date)
DESCRIPTION OF WORK NEEDED TO CORRECT DEFICIENCIES
4fol p/Ck, 41C, 'FS
I MATERIAL NEEDED FOR DEFICIENCY REPAIRS
JAM"
# TECHS HRS.
I - QTY. I DESCRIPTION, SIZE &
LADDER
Emerald Pire
Fire Sprinkder Specialists
11021 Cramer Rd. KPN - Gig HarborWA 98329
Office (253) 857-2056 - Fax (253) 857-2312 - Local 699 Contractor
AUTOMATIC SPRINKLER SYSTEMS
(One System per Report)
ZZ5) --I- �_�
ccu pa npy Mkai:�'
Occu�0y'AWdZ'ss-" OF
�N�r:Responsible Person: Phone Num
Building Owner: Phone Number:
Date of Inspection: -2-0 4 Type of Inspection: Quarterly>< -Annual E] Other E]
Testers Name (Please Print): C4 Y? le— FO WA State FSCC#
Q Y SYSTE
ow) conducted: ............................... VOW
i. �Trip test (dry trip or full fl �e�F] No
/PRE -ACTION SYSTEM:
System tripped in �'�econcls.
-1 .
2. All flow switches, supervisory switches and alarm bells tested: ..................... Yes E] No E] N/A F�
3. Alarm bell operates: ............................................................................. Yes E] No E] N/A E]
4. Flow tests conductet.A ................................................................... Yes E] No E]
Flow pressure: — I/ I psi 2-inch drain? ....................................... Yes F I NQ4�+-
5. Systems inspected anilubricated: .......................................................... Yes El No El N/A El
6. Air compressor refills system in 30 minutes: .............................................. Yes E] NoF
7. System drained and restored to normal operation: ..................................... Yes E] No E]
8. Were the heat actuation devices tested on pre -action and deluge system? ..... Yes 0 No El N/V�__
iT SYSTEM ANTI -FREEZE SYSTEM: Tested at
Wo tep
1. rip test conducted: .. .... ......................... ...... '*"* ... Yes [-] No E]
Staticpressure: 0 -- psi Flow pressure: 4 psi 2 inch drain? ....... Ye.5,� Noo N/A
2. Flow switches, supervisory switches and alarm bells tested: ..................... Yes Fj Non N/A F�
3. Alarm bell operates: ............................................................................. Yes EJ No 1771 N/A El
4. Systems inspected and lubricated: .......................................................... Yes El No El
5. Pressure regulating valves tested: ........................................................... Yes [-] No [-] N/A-ff,-
AUTOMATIC SPRINKLER SYSTEMS (continued) -SJ93
General:
1 Central Station Monitoring? .......................................................................... Yes?-r No F-1
Monitoring company name
2. Location of Sprinklers Dq y
WV-t - W631p,�
100% ....... Parking ......... E] Basement ......... F-1 Hallways ......... 0 Other...
3. Pumper connections and clapper valves unobstructed ....................................... Yes-E� No F-1
4. Sprinkler heads less than 50 years old ............................................................. YesEr No El
5. Sprinkler coverage is acceptable .................................................................... Yes -El' No F-1
6. Spare sprinkler heads are available ................................................................. YeHf' No F-1
7. Systems left in service .................................................................................. Yes-E5"No F
8. Valves are sealed or supervised ....................................................................... Yekj'No F
9. Signs are provided on valves .......................................................................... Yeir-�No El
10. City static water pressure psi. Dry
Problems Found: I N-
D,,A r4 QJ
11
fill
) b))'y 2, 0 t -7
Corrections Made: Date Corrected: Corrected By:.
SIGNATURE OF TESTER:
�20
AGENCY: Emerald Fire PHONE: 253-857-2056
MAILING ADDRESS: 11021 Cramer Road K]PN, Gig Harbor, WA 98329
EmERALDFiRE, LLC
Fire Sprinkler Specialists
H 021 Cramer Road KPN, Gig Harbor, Washington 98329
Ph (253) 857-2056 — Fax (253) 857-2312
SYSTEM CORRECTION REPORT
Date /0 -1(2 -(� FPB File #
System Type:
Alarm Sprinkler _Rangehood Standpipe Fire Escape — Other
Contact Person:
Narne of Facility: Ad =45-M-3
Address:.j=j< qq EJ
&(A3.. qZg24 Phone:
Have your service provider complete section below and return to this office within 7 days of
completion:
Date Corrections Made: Jt>
Company Making Corrections.- Emerald Fire
Company Contact Person: Bob Pagay Phone: 253-857-2056
Corrections Made:
ignat re of Technician
4
I. ISeil'i iliei: Edmonds, and
SNOHOMISH CO.
�_M
FIRE Mountlake Terrace
www.FireDistrictl.org
DISTR T
LOCATION: 2MIS HqhwWfM 00243
BUSINESS NAME: Rlc Aid DWSLore
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12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 42GI5701318
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FIRE DEPARTMENT COPY
MAILING ADDRESS
P.O. Box 3165
Harrisburg, PA 17105
With us, it's personal.
GENERAL OFFICE
30 Hunter Lane
Camp Hill, PA 17011
717.761.2633
September 17, 2014
Snohomish County Fire District 1
12425 Meridian Avenue South
Everett, WA 98208
ATTN: Inspector Ness
Sent via Certified Mail and Facsimile to: (425) 551-1272
RE: Fire Inspection Report
Rite Aid Store #5183
22515 Highway 99
Edmonds, WA 98026
Dear Inspector Ness -
In response to the Fire Inspection report dated August 18, 2014, for Store #5183 in
Edmonds, Washington, please see the outline below indicating actions taken:
o Vendor has been dispatched for emergency light to be serviced, work order WEB-
1181429 (EXHIBIT A); and
o Vendor has been dispatched to identify/install,:KN.OX--b-o-x-,--Wo—rk order WEB-
1180316 (EXHIBIT B).
Please do not hesitate to contact me should you require additional information.
Kind Regards,
Rite Aid Corporation
Stephanie Caiati
Director, Environmental Health and Safety
EXHIBIT A
Work Order WEB-1 181429
Page I of I
'.LXLLJiw— WORK ORDER:
WEB-1181429
Date Reported: 9/16/2014 1:07:31 PM
Date Committed: 9/16/2014 1:10:17 PM
Priority: SCHEDULED WORK
Operator ID: SHEAROD LEARN
Requester Name: MANAGER, STORE Alternate Contact: ASSISTANT MANAGER
Telephone Number: 425-670-2667 Alt Contact Phone: 425-670-2667
Cost Center: 101010
Location ID: RIT-05183 - (NPT)
Description: RITE AID STORE - 05183
.Mail Name:
Address: 22S1S HIGHWAY 99
EDMONDS, WA 98026-8373 US
Service Location:
Request Code: VIOLATION RESOLUTION
Store is in receipt of NOV from the Snohomish CO. Fire District dated 8/18/14. Compliance
9/18/14. Copy Attached. Investigate and repair emergency light by back lunch room.
Provider: 23881 - SOLIS LIGHTING & ELECTRICAL SERVICES, INC. - PIN:79993
Provider Contact: SOLIS LIGHTING & ELECTRIC
Provider Telephone: 949-443-2290 DNE: $750.00
Provider Fax: 949-248-8621 Release #:
Provider will observe all relevant current code authorities' rules and regulations, including safety regulations, and
be licensed, insured, and bonded, as required by applicable state law where work is performed. Provider must
check in by calling 1-866-532-9931 when arriving on site.
Provider will not exceed DNE stated above without prior approval. If work is expected to exceed this amount,
technician must call the Service Solutions call center at 1-866-532-9927 and provider's service desk must
submit a Reauest for Proposal or Ouote on-line.
To ensure the e7fficient and timely processing of an invoice, follow the instructions set forth below.
To avoid a delay in processing your invoice, please follow these instructions:
Technician must check in and out of the store using the above IVR (Integrated Voice Response) number 1-866-'
532-9931 (failure to check in and out with the store and IVR system could result in invoice challenge and poor
provider scorecard rating).
Invoices submitted with missing information will be challenged on-line automatically. Invoices that exceed the
DNE (Do Not Exceed) stated above or an approved increase.
Submit your company's work ticket indicating their hours on -site, # of technicians, and description of work
performed, complete with Rite Aid store management signature and store stamp. You must submit your invoice
online (www.fmi)ilot.com/riteald), and attach the signed/stamped work ticket or your payment will be delayed.
Paper invoices sent to Rite Aid will not be paid.
** INVOICES SUBMITTED 4S DAYS OR MORE FROM COMPLETION OF WORK WILL NOT BE PROCESSED
FOR PAYMENT **
If these directions are not followed accurately, or if the Invoice total is greater than the DNE or the approved
increase, the invoice will be returned to you without payment.
https:llriteaid.fmpilot.comlriteaidIDeskICustlriteaidIWOForm.asp?comments=N&wonum=... 9/17/2014
EXHIBIT B
Work Order WEB-1 180316
Page I of I
I iki k I WORK ORDER:
WEB-1180316
no.
ME=
Date Reported: 9/15/2014 7:42:03 AM
Date Committed: 9/15/2014 7:44:05 AM
Priority: - SCHEDULED WORK
Operator ID: Francis McCaffrey
Requester Name: MANAGER, STORE Alternate Contact: ASSISTANT MANAGER
Telephone Number: 425-670-2667 Alt Contact Phone: 425-670-2667
Cost Center: 101010
Location ID: RIT-05183 - (NPT)
Description: RITE AID STORE - 05183
Mail Name:
Address: 22515 HIGHWAY 99
EDMONDS, WA 98026-8373 US
Service Location:
Request Code: VIOLATION RESOLUTION
NOV from the Snohomish CO. Fire District dated 8/18/14. Compliance 9/18/14. Copy
Attached. - Dispatch a tech to the site and locate Knox Box. If no Knox Box onsite, contact FM
and install one.
'Provider: 02946 - ACADEMY FIRE PROTECTION - PIN:98797
Provider Contact: ACADEMY FIRE PROTECTION
Provider Telephone: 347-473-7246 DNE: $709.00
Provider Fax: 347-473-7349 Release #:
Provider will observe all relevant current code authorities' rules and regulations, including safety regulations, and
be licensed, insured, and bonded, as required by applicable state law where work is performed. Provider must
check in by calling 1-866-S32-9931 when arriving on site.
Provider will not exceed DNE stated above without prior approval. If work is expected to exceed this amount,
technician must call the Service Solutions call center at 1-866-S32-9927 and wovider's service desk must
submit a Reauest for Proposal or Ouote on-line.
To ensure the efficient and timely processing of an invoice, follow the instructions set forth below.
To avoid a delay in processing your invoice, please follow these instructions:
Technician must check in and out of the store using the above IVR (Integrated Voice Response) number 1-866-
532-9931 (failure to check in and out with the store and IVR system could result in invoice challenge and poor
provider scorecard rating).
Invoices submitted with missing information will be challenged on-line automatically. Invoices that exceed the
DNE (Do Not Exceed) stated above or an approved increase.
Submit your company's work ticket indicating their hours on -site, # of technicians, and description of work
performed, complete with Rite Aid store management signature and store stamp. You must submit your invoice
online (www.fmi)ilot.com/riteald , and attach the signed/stamped work ticket or your payment will be delayed.
Paper invoices sent to Rite Aid will not be paid.
** INVOICES SUBMITTED 45 DAYS OR MORE FROM COMPLETION OF WORK WILL NOT BE PROCESSED
FOR PAYMENT
If these directions are not followed accurately, or if the, invoice total Is greater than the DNE or the approved
increase, the invoice will be returned to you without payment.
https:Hriteaid.fmpilot.comlriteaidIDeskICustlriteaidIWOForm.asp?comments=N&wonum=... 9/17/2014