23725 EDMONDS WAY (2)4�uof ljoy I E PRtVE'NTI6N
FR
IIINISPECTION REPORT
Serving Brier, L�ufrturids, and 12425 Meridian Ave S
SNOHOIfflSITCO. ZEDIVIONDS
Molintlake Terrace Everett, WA 98208 0 BRIER
F1 E
Phone (425) 551-1200 0 MOUNTLAKE TERRACE
Fax (425) 551-1272 0 UNINCORPORATED
DI www.FireDistrictl.org
Ti
FREQUENCY STATION & SHIF`�
LOCATION: 23725 Edmonds Way 98020 Annual 20-D
Olympic View Water' Dist./Shop 4257747769 SCHEDULED Aug 2017
BUSINESS NAME: PHONE: DATE DUE
MAILING UFIR
ADDRESS: 237,25 Edmonds Way, Edmonds, WA 98020
HOME PHONE:
BUSINESS OWNER:
EMERGENCY-1: Olympic View Water HOME PHONE: 2M52fTf'60-0 CURRENT
KEY ACCESS-2: HOME PHONE: CITY YES NO
BUSINESS
EMAIL: LICENSE
INITIA�NSPECTION DATE
PERSON CONTACTED:
NAME OF INSPECTOR:
FIRE SYSTEMS: AS 10/15 FA 4/14 FE 5/14 12:00:00 AM
Date Last Serviced:
Fire Protection Contrac tors since 1930
jai
VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656
T
WA.: VI-KI-NA-S373NT LEVEL N 602 California Way, Longview, WA 98632,360,425.7620
Firp- _Qnrinklar Inanat-tinn Ramirt -110%4 03
REPORT TO: /�iA Z6;Z A JOB NO. 62S-27' 4 DATE: /,o - /,2
STREET: BLDG./LOCATION:
CITY/STATE: INSPECTOR: I V1%
1.GENERAL YES N.A. NO
a. Is the building occupied ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Is occupancy the same as previous Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C. Are all systems In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Are all fire protection systems the same as last Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . - - - -
a. Is the building completely sprinklered ? - - - - - - - - - - - - - - - - - - - - - - - -- --- - - - - - - - - - - - 7
f. Are all new additions and building changes properly protected ? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Is all stock or storage properly below sprinkler piping ? . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . .
h. Was property free of fires since last Inspection ? (Explain any fire on Page 2) . . . . . . . . . . . . . . ... . . ...
1. In areas protected by wet systems, Is building properly heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected against ;he co;d �7
2. CONTROL VALVES (See Section 17)
a. Are all sprinkler system main control valves open ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Are all other control valves In proper position ? - - - - - - - --- - - - - - - - - - - - - - - - - - - -- 1.
c. Are all control valves In good condition and sealed or supervised ? . . . . . . . . . . . . . . . . . . . . . . .
3. WATER SUPPLIES (See Section 18)
a. Was a water flow test preformed and were the results satisfactory ? . . . . . . . . . . . . ... . . . . . . . . . . . . ..
4. TANKS, PUMPS, & FIRE -DEPARTMENT CONNECTIONS
r 'NA
a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? . . . . . . . . . . . . . . .
11-41. _1/ -7-,P�5 T.",I) - f
b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves tight ?
5. WET SYSTEMS (See Section 13)
a. Are cold weather valves open or closed as necessary ? - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - -
b. Have antifreeze systems been tested and left In satisfactory condition ? Temp. ? . . . . . . . . . . . . . . . . . . .
c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? - - - - - - - - - - - - - - - - - - - - - -
6. DRY SYSTEMS (See Section 14)
a. Are dry valve(s) In service and In good condition 7 . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . .
b. Are pressure and priming water levels normal.? - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - -
c. Is air compressor In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Were low points drained during fall and winter Inspections ? . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . j
9. Are Quick- opening devices In service ? . . . . . . . . . . . . . . . . . . . . . . . . .
f. Has. piping been checked for stoppage within the past ten (10) years ? . . . . . . . . . . . . . . . . . . .... . . . . . .
g. Has piping been checked for proper pitch within the past five (5) years ? - - - - - - - - - - - - - - - - - - - - - -
h. Have dry valves been trip tested satisfactorily as required 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Are dry valves adequately protected from freezing ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .
1. Are valve house and heater conditions satisfactory ? - - - - - - -- - - - - - - - - - - - - - - - - - - - . . . . . .
7. SPECIAL SYSTEMS (See Section 16)
a. Were valves tested as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- -
b. Were all heat -responsive systems tested and were the results satisfactory ? -- - - - - - - - - - - - - - - - - - --- - - - -
c. Were supervisory features tested and weri the results satisfactory ? . . . . . . . ... . . . . . . . . . . . . . . . . . .
8. ALARMS
a. Is the water motor and gong test satisfactory ? - - - . . . . . . ... . . . . . . . . . . . . . . . . . . . . . .
b. Is the electric alarm test satisfactory ? . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Is the supervisory alarm service test satisfactory ? Monitoring Co. Ph.: Code:'
9. SPRINKLERS'- PIPING Iw;lv 090;�e Alotv;-,0125 Syf.%,-n2 -7 - N&
a. Are all : prinkler heads In good condition, not obstru cted and free from corrosion or loading ? . . . . . . . . . . . . . ... . . .
b. Are all :prinkler heads less than fifty (50) years old? Head Manufacturer: d(I Date of head
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: bUILDING COPY
e.-
4
Fire Protection Contractors since 1930
virJNG'AUTOMATIC SPRINKLER COMPANY 3434 Rrst Ava So., Seeffile, WA 98134, 206. 622. 46M
WA.: VA40-MA-S373NT LEVEL'N SIX Cafftmin My, Longvilw WA 350.425.7620
Fire Sprinkler Inspection Report
Page:W2
9. SPRINKLER / PIPING (Continued)
YES
N.A.
NO
c. Are extra sprinkler heads readily available ? -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
-
101'
d. Is condition of piping, drain valves, check valves, hangers, pres u r 9 gel -
au _,open sprinklers, and strainerssattlactoiry ?
a. Are all sprinklers of proper temperature rating? . . . . . . . . . . . . . t . . . . . . . . . . . . . . . . .
.
f. Are portable fire extinguishers In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
g. Is hand hose on sprinkler systems satisfactory ? - - - - - - - - - - - - - - ---- - - - - - - - - - - - - - - - -
-
10. Date Dry System Piping last chocked for stoppage .. . . . . . . . . . . . . . . 11", .. . . . . . . . . . . . . . . . .
.
11. Date Dry System Piping last checked for proper pitch - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - -
--
12: Date Dry Pipe Valve last trip tested -- - - - - - - - - . . . . . . . . . . . . . . ... �. - - - - - -
-
13. Wet systems- Number Make I Model I Year.
14. Dry Systems: Number: Make I Model / Year.
15. Accelerator: Make / Model / Year:
16. Special Syiitelms: Number: —Type:
Make / Model / Year CondMon
17. CONTROL VALVES
a. City Connection Control Valves - - - - - -
b. Tank Control Valves - - - - - - - - -
c. Pump Control Valves - - - - - - - - -
d. Sectional Control Valves - - - - - - - - -
a. System Control Valves - : . . . . . . .
It WATER FLOW TEST
Number
Type
Open
yes No
Secured
Yes No
Closed
yes No
sign
Yes No
Condition
61
Of z
a. Water Pressure Source: g city, pTank, 0 Fire Pump, Water Flow Test taken ? If not, reason:
0 � I
Test Pipe Location
Size Test Pipe
Pressure Before
Flow Pressure
Pressure After
Aw
(010,75 kt
-7 IC
19. Explanation of any "No" answers:
20. Recent changes In building occupancy or fire protection equipment:
21. Adjustments or corrections made:
14
22. Desirable Improvements:
23. Has building owner representative been notified of any deficiency to the fire protection system? 0 Yes, 0 No, Person notif , led:
If answer Is "No",explain:
24. Inspector's Signature: IWItness (property owner / lessee) and date':
7— 1
WHITE: VIKING COPY YELLOW INVOICE COPY PINK: FIRE DEPARTMENT COPY - GOLD: BUILDING COPY
::5'
Fire Protection Contractors since 1930
NG AUTOMA`nC SPRINKLER COMPANY
3434 First Ave. So., Seattle, WA 98134,.206.622.4656
WA.: V1-K1-NA-S373NT.LEVEL 1// 602 California Way, Longview, WA 98632,360,425.7620
Fire Sprinkle I ection Report
r n P. Page:W2
REPORT TR:.( OB NO. DATE.:.:
U�1'11�1) -j—A i,
ST EET: BLDG./LOCATION:
CITY/STATE: INSPECTOR:
I.GENERAL
a. Is the building occupied, ? - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - -
b. Is occupancy the same a. previous Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Are all systems In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Are all fire protection systems the same as lost Inspection ? . .... . . . .
. . . . . . . . . . . . . .
9. Is the builldl6l; completely iprfWkie'
red ? - - - ---- - - - . . . . . . .
I. Are all new additions and building changes properly protected ? . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Is all stock or storage properly below sprinkler piping ? . . . . . . . . . . . . . . . ... . . . . . . . . . . . . .
h. Was property free *of fires since last Inspection ? (Explain any fire on Page 2) . . . . . . . . . . . . . . . . . . . . . . .
1. In areas protected by wet systems, Is building property heated, I.e.: blind attics, perimeter areas, and am all exterior openings protected against the cold
2. CONTROL VALVES (See Section 17)
a. Are all sprinkler system main control valves open ? . . . . . . . . . . . . . . . . . . . . . . . . .
b. Are, all other control valves In proper position ? .
7 7
,c. Are'afl: control - �alves In 66od condition and'iealed'or'supiervised .. . . . .
3. WATER SUPPLIES -(Sea Sectlon,.18)
a. Was a water flow test. -preformed and were the results satisfactory ? - --- - - - - -
4' TANKS, PUMPS, -&,FIRE DEPARTMENT CONNECTIONS
a. Are fire pumps, avl;�Ilnks resevoIrs and pressure tanks In good condition and properly maintained ? . ... . . . . . .
b. Are Fire Department i2nnectlons In satisfactory condition, couplings free, caps In place and check valves tight ? . . . . . .
5. WET SYSTEM (See Section 13)
a. Are cold weather valves open or closed as necessary ? . . . . . . . . . . . . .. . . . . . . . . . . . .
b. Hkve arilifted'ie systems been tested and left In satisfactory cdAR164,11' Temp. ? — - - - - - - - - - - - - - - - -
c. A4�larrn valves, water flow Indicators and retard chambers In satisfactory condition ?
6. DRY SYSTEMS (See Section 14)
A a d!y valve(s) In service and In good condition ?
b. Are pressure and priming water leveis normil ?
C. Is air compressor In good'condition ? - - - - ------- --- - - - - - - - - - - - - - - - - - - - - -
d. Word low points drained during fall and winter Inspections ? . . . . . . . . . . . . . . .
e.Ar c opening devices In service ? - - - - - - - - - - - - - - - -
. . . . . . . . . . . . ..
I L"plp�io,b'be'n checked for stoppage within the past ton ye
H . . . . . . . . . . .
9. Has piping been checked for proper'01tch within,the past five (5) years ? . . . . . . . . — - - - - - - - - - - - - - -
h. Have dry valves been trip tested satisfactorily as required ? . . . . ... . . . . . ... . . . . . . . . . . .
1. Are dry valves adequately protected from freezing ? . . . . . . . . . . . . . . . . . . . .
A -valve house and heater conditions satisfactory ?
re - - - - - - - - -
7. SPECIAL S EMS (See'Secilon 16)
a. Were valves tested awrequired ?
b. Were all hdat-ei�ponslve systems tested and were the results satisfactory
'�pery 6r dwdr�-thd'resulti sit 9 actor
C. �er� iu hs' y featui�s idsted a I f ?
8 ALARMS
a. Is the water motor a6d gong test satisfactory .. . . . . . .
. . . . . . . . . . . . . . .
b. Is the electric alarm test satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Is the supervisory alarm service test satisfactory ? Monitoring Co. Ph.: Code:
9. SPRINKLERS - PIPING 04Wyqje' rAA 1 0 0;�', ce A;V ftAen- Coe
a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or loading ? . . . . . . . . . . . . . . . . *
b. Are all sprinkler heads less than fifty (50) years old? Head Manufacturer: Date of head :.9-*il
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
V_
Flre� 0'r'ot6ciibn Contraciors since 1930
VIKING 4MMiTIC SPRINKLER comPANY 3434 Rn;t Am So., Seeft WA 98134, 206. 622. 4656
WA.. VI-KI-NA-S373NT LEVEL N 602 CAWN111119 Way, Longview, WA 425. 7620
Fire, Sp c n Page�W2
!inkler Inspe lio Report
9. SPRINKLER I PIPING (Continued) YES N.A. NO
c. Are extra sprinkler heads
readily available ? . . . . . . . . . . . ... . . . ..... . . . . . . ... . . . . .
7
ngers, pr=" open sprinklers, and stialners sa"!a"
Is condition of piping, drain valves, check valves, he _ac - y
?
a. Are all. sprinklers of proper temperature rating? -
- - ---- - - - - - - - - -
f. Are portable fire extinguishers In good condition ? - - - - - - - - - - - - - - - - - - - - - - - - - - - L _J
g. Is hand hose on sprinkler systems satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F
10. Date Dry System Piping last chocked for stoppage -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - InA
11.- Date Dry System Piping last chocked for proper pitch - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
12. Date Dry Pipe Valve last trip tested -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
13. Wet systems: Number- Make I Model I Year.
14. Dry Systems: Number: Make/ Model/ Year.
15. Acceieratc;r�Maki_/ liodil_/
16. SpeclalSystems: Number: -Type:
Make / Model / Year: Condition
17. CONTROL VALVES
a. City Connection Control Valves . . . . . .
b.Tank Control Valves - - - - - - - - -
C. PUMP Conirai valves
A. Sectional Control Valvea
a. System, Control Valves . . . ... . .
'18. WATER FLOW TEST
a.Water Press�r-iPSource -.�cfty, 07ank, 0 Fire Pump, Water FlowTest'taken ? If not, reason:
Test Pipe Location
Size Test Pipe
Pressure Before
Flow Pressure
Pressure After
NT 21;4,40A.
542
19. Explanation of any "No" answers:
J
20. nt changes -in building occupancy or fire protection equipment:
23
Has building owner / representative been notified of any deficiency to the fire protection system?/Y.s 0 No, Person notified
It answer Is "No",explain:
24. Inspector's Signature Witness (property owner / lessee) and date:
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
Fire Protection Contractors since 1930
Ncer
V11<114C(AUTOMATIC SPRlNKL,ER C15IMP41Nly-j'?;� 3434 First Ave. So., Seattle, WA 98134, 206.622.4656
WA.: VI-KI-NA-S373NT LEVEL M 602 California Way, Longview, WA 98632,360,425.7620
Fire Sprinkler Inspection Report Page: 1 'of 2
REPORTTO: /71 \JA-) e J 0 8 N 0. V, 01/ DATE: JI!!2
STREET: 7-71 E71002--J)) BLDG./ LOCATION:
_94
CITY / STATE: �rl 4A.-O
INSPECTOR:
,I.GENERAL
a. Is the building occupied ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Is occupancy the same as previous Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Are all systems In service ? . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . .. . . . . . . . .
d. Are all fire protection systems the same as last Inspection ? . . . . . . . . . . . . . . . . . . . . . . . . . . I . .
a. Is the building completely sprinklered ? . . . . ... . . . . . . . . . . . . . . . . . I . . . . . . . . .. . . .
I. Are all now additions and building changes properly protected ? - - - - - - - - --- - - 0 . . . . . . . . . . . . . .
g. Is all stock or storage properly below sprinkler piping ? . . . .. . . . . . . . ... . . . . . . . . . . . . . . . . .
h. Was property free of fires since lost Inspection ? (Explain any fire on Page 2) . . . . . . . . . o . . . . . . . . . . . . .
1. In areas protected by wet systems, Is building properly heated, Le.: blind attics, perimeter areas, and are all exterior openings protected against the cold
2. CONTROL VALVES (See Section 17)
Are all sprinki r system main control valves open ? . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Are all other c:ntrol valves In proper position ? . . . . . . . . . ... . . . . . . . . . . . . . ... . . . . . . .
c. Are all control valves In good condition and sealed or supervised ? . . . . . . . . . . . . . . . . . . . . . . . . . .
3. WATER SUPPLIES (See Section 18)
a. Was a water flow test preformed and were the results satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . .
4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS
ty t nkq, resevoirs and pressure tanks In good condition and properly maintained ? . . . . . . . . . . . . . .
a. Are fire pumps, erav`�Iti
b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves tight e.,
5. WET SYSTEM (See Section 13)
a. Are cold weather valves open or closed as necessary ? . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .
b. Have antifreeze systems been tested and left In satisfactory condition ? Temp. ? . . . . . . . . . . . . . . . . .. .
c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? . . . . . . . . . . . . . . . . . . . .
6. DRY SYSTEMS (See Section 14)
a. Are dry valve(s) In service and In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Are pressure and priming water levels normal ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Is air compressor In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Were low points drained during-f,all and winter Inspections ? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a. Are Oulck- opening devices In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
f. Has piping been checked for stoppage within the past ton (10) years ? . . . . . . . . . . . . . . . . . . . . . . . . .
g. Has piping been checked for proper pitch within the past five (5) years ? . . . . . . . . . . . . . . . . .. . . . . . . .
h. Have dry valves been trip tested satisfactorily as required ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Are dry valves adequately protected from freezing ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Are valve house and heater conditions satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. SPECIAL SYSTEMS (See Section 16)
a. Were valves tested as required ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Were all heat -responsive systems tested and were the results satisfactory ? . . . . ... . . . . . . . . . . . . . . . . .
c. Were supervisory features tested and were the results satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . .
8. ALARMS
a. Is the water motor and gong test satisfactory ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Is the electric alarm test satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c.. Is the supervisory alarm service test satisfactory ? Monitoring Co. M, A I VV fl _ C." � Ph.: Code:
9. SPRINKLERS - PIPING oj; o tymPie- 1,vAT.,pe, meiv ytqiem
a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or loading ? .. . . . . . . . . . . . . ... . . .
b. Are all sprinkler heads less than fifty (50) years old? Head Manufacturer: V1A'1'.-,u6- Date of head :_ -,) -4 ) j
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
NO
VI
Fire Protection Contractors since 1930
3 4uT6mA-nc SPRINkUh COMPANY 3434 Rrst Ava Sa; Seatift WA 98134, 206. 622. 46M
WA.: V1-K1-M4b73A1`T LkVEC Iff 6a2 Caftirrili My, Longvilow, WA 98M, 360. 425. 76W
Fire Sprinkler Inspection Report Page:202
9. SPRINKLER / PIPING (Continued)
YES, N.A. NO
c. Are extra sprinkler heads readily available ? .
. . . . .... -----------------------
7
d. Is condition of piping, drain valves, check valves, hangers, pressure gauges; open sprinklers, and strainers sa#fackwy ?
e.-Are alUsprin kiers-of proper temperature rating?-
1,7
d
f. Are portibie ilre exting�lshers In,goo iti* �' �i
g. Is hand hose on sprinkler systems satisfactory ? -- - -
- - - - - - - - - - -
. . .
. .. .
10. .'Date Dry System Piping last checked for stoppage -- - - - -
- - - - - --- - - - - - - -
- - - - --- - - - - -
--- -
11. Date Dry System Piping last checked for proper pt tch -- - - -
- - - - - - - - -- - - - - -
- - - - - - - - - - -
--- -
12. Date Dry Pipe Valve last trip tested -- - - - - - - - - -
- - - - - - - - - - - - - -
- - - - - - - - - - -
- - -
13. Wet systems: Number: Make I Model Yea,
%�x -�e
14. Dry Systems: Number: Make / Model Year:
15. Accelerator: Make / Mo del / Year:
16. Special Systems: Number:— Type:
Makel Model*/ Year:
Condition
17. CONTROL VALVES
a. City Connection Control Valves - - - - - -
b. Tank Control Valves - - - - - - - - -
c. Pump Control Valves - - - - - - - - -
d. Sectional Control Valves - - - - - - - - -
a. System Control Valves . . . . . . . . .
Number
Type
Open�o
Yes
Y.Secured
8 No
Closed
Yes No
SI n
Si
Yea No
Yes
Condition
2
E X 1
7
z
C",
18. WATER FLOW TEST
a. Water Pressure Source Cftv, 07ank, 0 Fire Pump, Water Flow Test taken'? Ifnot,reason:
:Test Pipe Location
Size Test Pipe
Pressure Before
Flow Pressure
Pnissure After
19., Explanation of any "No" answers:
20. Recent�_Chafiges In building occupancy or fire protection equip nt:
A�1_4�11: .�, Tr.. I
21. Adjustments or corrections made:
22.. Desirable,improvements:
a 'niative been'notified of any deficiency to the fire pr tection system ?RY rson notified:
.23.� Has building owner repie a 0 as C3 No, Pe
It answer Is "No",explain:
24. Inspector's Signature: Witness (property owner lessee) and date:
WHITE: VIKING COPY YELLOW: INVOICE COPY 'PINK: FIRE DEPARTMENT COPY GOLD: BUILDINGCOPY
SNOHOMISH' CO.
I RE
DIST]
Serving Briei: �dnionds, and
Mountlake Terrace
uwwFireDistrictl. org
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272 -
LOCATION: 1172.5 Edmonds Way MOM
BUSINESS NAME: iDLvrTipiG'Vicw WaLcr DitiL/Stmp PHONE:
MAILING I
ADDRESS: 237265 Edmon& Way, bdrmndti., WA 03020
425774
FIRE PREVENTION
INSPECTION REPORT,.�
SEDMONDS
BRIER
[I MOUNTLAKE TERRACE,
[I UNINCORPORATED
BUSINESS OWNER:
HOME PHONE:
EMERGENCY-11:
Olympic Maw WaLcr
HOME PHONE:
20&6,4000 "' CURRENT
KEY ACCESS-2:
EMAIL:
HOME PHONE:
CITY YES NO
BUSINESS
LICENSE
PERSON CONTACTED:
INITIAL INSPECTION DATE
NAME OF INSPECTOR:
CIA
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HAZARDS FOUND AND LOCATIONS COMMUNIbNFIGIlt
2
2
3
3
4
4
51
5
6
6
7
4-
7
---
I AG.REE TO CORREdT THE ABOVE YIOLATION(S) IN THE NEXT 30 DAYS'X
lst RE -INSPECTION
2nd RE -INSPECTION
FINAL RE
EXTENSION
-INSPECTION
VIOLATIONS
DATE DOE.
DATE DUE:
GRANTEDTO:
DATE DUE:
CITED.
PERSON"
PERSON
PERSON
CONTACTED:
CONTACTED:
CONTACTED:
1
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
E:
DATE:
3
VIOLATIONS
VIOLATIONS
PRE -CITATION
CITATION ISSUED
5
1
LETTER SENT
NUMBER:
4
CODE
5
Z
6
2
6
DATE:
SECTION:
RETURN RECEIPT,,.
3
7
3
7
RECEIVED "
6
DISPOSITION:
.4
J8
4
18
DATE:
LETTER NEEDED F] YES NO
I LETTER,NEEDED F] YES NO
1
8
FIRE DEPARTMENT COPY
J
Serving Brier, Edmonds
.,Mountlake Terraceand
FTthe Town of Woodway
www.FireDistrictl.org
FIRE PREVENTION
12425 Meridian Ave S INSPECTION REPORT
0 EDMONDS
Everett, WA 98208 0 BRIER
Phone (425) 551-1200 OWOODWAY
0 MOUNTLAKE TERRACE
Fax (425) 551-1272 0 UNINCORPORATED
" FREQUENCY STATION & SHIFT�
LOCATION: 23725 0 Way Edmonds 98026 1 20-1)
BUSINESS NAME: oi SCHEDULED
ympic View Water Dist./Shop PHONE: 4257747769 DATE DUE � Aug
MAILING LIFIR 0
ADDRESS: 23725 Edmonds Way, Edmonds, W.A
BUSINESS OWNER: HOME PHONE:
Email:
EMERGENCY-1: Ol, pic View Water HU L PHL)NL: 206546151010 CURRENT
KEY ACCESS-2: -4rr. HOME PHONE: CITY . YES NO
BUSINESS
LICENSE
`4 INITIAL INSPECTION DATE
PERSON CONTACTED: e�
NAME OF INSPECTOR:
FIRE SYSTEMS: FE5-//3- /0/13 F/Jc— /0//;Z- F-5
HAZARDS FOUND AND LOCA
_�TIONS COMMUNICATIONS
Ar7r)d
2
2
3
3
4
4
5
5
6
6
7
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
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
INSPECTOR:
INSPECTOR:
INSPECTOR:
2
DATE:
DATE:
DATE:
3
I VIOLATIONS
1 5
VIOLATIONS
1 5
PRE -CITATION
LETTER SENT
CITATION ISSUED
NUMBER:
4
2
6
2
6
DATE:
CODE
SECTION:
3
7
3
7
RETURN RECEIPT
RECEIVED
6
4
18
4
18
DATE:
DISPOSITION:
7
LETTER NEEDED [] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
7, '?1" -',77-7, 7,77
KIN&
Fire Protection Contractors since 1930
VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656
WA.: VI-KI-NA-S373NT LEVEL M 602 California Way, Longview, WA 98632,360,425.7620
Fire Sprinkler Inspection Report
REPORT TO: t E %.J A-TEV-4- 45 aW A k JOB NO. 09 DATE: I o -i,
STREET: ZZ ZZ5 LEJO tA bOl:)�K AL
—BLDG./ LOCATION:
*)& INSPECTOR:
9 ';� � 41-11 ?- lr_ 0 1
CITY/ STATE: A S
1.GENERAL
Page:lof2
a. Is the building occupied ? - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - -
b. Is occupancy the same as previous Inspection ? . . . . . . . . . . I . . . . . . . . . .
. . . . . . . . . . . . . .
c. Are all systems In service ? - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - -
d. Are all fire protection systems the same as last Inspection ? - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - -
a. Is the building completely sprinklered ? - - - - - - - - - - - - - - - - - - - - - - -
- - - - - - - --- - - - - -
1. Are all new additions and building changes properly protected ? - - - - - - - - - - - - - -
- - - - - - —
g. oc or storage properIV:66elow sprinkler piping? - - - - - - - - - - - - - -
- - - - - - - . . . . . . .
h. Was property free of fires since last inspection ? (Explain any fire on Page 2) - - - - - - - - - -
- - - - - - - - - - - - - -
1. In areas protected by wet systems, Is building property heated, Le.: blind attics, perimeter areas, and are all exterior openings protected against the cold ?
2. CONTROL VALVES (See Section 17)
a. Are all sprinkler system main control valves open ? - - - - - -- - - - - - - - - - - - - -
- - - - - - - - - - - - - -
b. Are all other control valves In proper position ? - - - - - - - - - - - - - - - - - - - ; -
- - - - - - - - - - -
c. Are all control valves In good condition and sealed or supervised ? - - - - - - - - - - - - -
- -- - - - - - - -
3. WATER SUPPLIES (See Section 18)
a. Was a water flow test preformed and were the results satisfactory ? - - - - - - - - - - - - -
- - - - - - - - // - - - - - -
4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS
//
a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? .
. . . . . . . . . . . . . .
b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves
tight ? - - - // - - - - - - - - -
5. WET SYSTEM (See Section 13)
a. Are cold weather valves open or closed as necessary ? - - - - - - - - - - -- - - - - - -
- - - . . . . . . . .
b. Have antifreeze systems been tested and left In satisfactory condition ? Temp. ? — - - - -
- - - - - - - - - - - - - -
c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? - - - - - - -
- - - - - - - - - - - - - -
6. DRY SYSTEMS (See Section 14)
a. Are dry valve(s) In service and In good condition ? - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - -
b. Are Rressure and priming water levels normal ? ----- - - - - - - - - - - - - - -
- - - - - -
c. Is air.compressor In good co�dltion ? - - - - - --- - - - - - - - - - -
- -
d. Were 16W 06 Ints draiinied'durint�g*'f'all and winter Inspections ? - - - --- - - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - - - - - -
a. Are Oulck- opening devices In service ? - - - - - - - - - - - - - - - - - - - --- - -
- - - - - - - - - - - - - -
f. Has piping been checked for stoppage within the past ten (10) years ? - - - - - - - - - - - -
- - - - - - - - - - - - - -
g. Has piping been checked for proper pitch within the past five (5) years ? - - - - - - - - - - -
- - - - - - - - - - - - - -
h. Have dry valves been trip tested satisfactorily as required ? - - - - - - - - - - - - - - - -
- - - - - - - - - - - - -
1. Are dry valves adequately protected from freezing ? - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - -
1. Are valve house and heater conditions satisfactory ? - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - - - -
7. SPECIAL SYSTEMS (See Section 16)
a. Were valves tested as required ? - - - - - - - - - - - - - - - - -- - - - - - - -
- - - - - - - - - - - - - -
b. Were all heat -responsive systems tested and were the results satisfactory ? - - - - - - - - - -
- - --- - - - - - - - - - -
c. Were supervisory features tested and were the results satisfactory ? - - - - - - - - - - - - -
- --- - - - - - - - - - - -
8. ALARMS
a. Is the water motor and gong test satisfactory ? - - - - - - - - - - - - - - - - - - - -
- - - - - - - - - - - --
b. Is the electric alarm test satisfactory ? - - - - --- - - - - - - - - - - - - - - - - -
- - - - - - - - - - - -
c. Is the supervisory alarm service test satisfactory ? Monitoring C 1A t�, v �e� r- F. e t;�' Ph.:
Code:
9. SPRINKLERS - PIPING
a. Are all sprinkler heads In good condition, not obstructed and free from corroslogior loading ? - - - -
- - - - - - - - --- - - - -
b. Are all sprinkler heads less than fifty (50) years old ? Head Manufacturer
Date of head
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY
GOLD: BUILDING COPY
Fire Protection Contractors since 1930
VIKING AUTOMATIC SPRINKLER COMPANY- 3434 Rist Ave. Sa, Seatille, WA 98134, 206. 622. 4656
WA.: V1-K1-NAS373NT LEVEL N 602 Cafftmille Way, Longview, WA 981W, 360. 425. 7520
Fire Sprinkler ft§pection Report Page: 2of 2
9. SPRINKLER / PIPING (Continued) YES N:A. NO
c. Are extra sprinkler heads readily available ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, and strainers satillactary ? - - - - - - - - -
a. Are all sprinklers of proper temperature rating? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
f. Are portable fire extinguishers In good condition ? - - - - - — - - - - - - - - - - - - - - - - - - - 7 -- - - - - -
g. Is -hand hose on sprinkler systems satisfactory ? - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - -
10. Date Dry System Piping last checked for stoppage --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
11. Date Dry System Piping last checked for proper pitch - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -
12., Date Dry Pipe Valve last trip tested — - - - - - - - - - - - - - - - - --- - - - - - - - - - - - - - - - - --- -
13. Wet systems: Number:
--L—Make/ Model /Year: tJ
14. Dry Systems, Number: Make / Model I Year:
15. Accelerator: Make / Model Year:
16.
,,""Ia! Systems: Number:—Typp:
Make / Model / Year: Condition
17. CONTROL VALVES
a. City Connection Control Valves - - --- - -
b. Tank Control Valves - - - - - - - - -
c. Pump Control Valves - - - - - - - ---
d. Sectional Control Valves - - - - - - - - -
e. System Control Valves - _: - - - - - - -
mns��
A
IS. -WATER FLOW TEST
a. Water Pressure Source : 0 City, OTank, 0 Fire Pump, Water Flow Test taken ? — If not, reason:
Test Pipe Location
Size Test Pipe
Pressure Elefore
Flow Pressure
Pressure After
19. Explanation of any "No" answers: — LP
20. Rec6nt changes In building occupancy or fire protection equipment:-
21. Adjustments or corrections made:
22. Desirable Improvements: 0144
ff
23. Has building owner representative been notified of any deficiency to the fire protection system? 0 Yes 0 No, Person notified:
If answer Is "No",explain-
Witness (property owner / lease
24. Inspector's gnature. Pe)anddat,
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
Fire Protection Contractors since 1930
VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656
WA.: VI-KI-NA-S373NT LEVEL M 602 California Way, Longview, WA 98632,360,425.7620
Fire Sprinkler Inspection Report Page:lof2
REPORT TO: 004 NA_�f C' t JOB NO. 15 15e DATE: 14 1-1
STREET: "'T
BLDG. / LOCATION:
CITY/STATE: INSPECTOR: � 10
r4 Lc�L Z%
I.GENERAL
a. Is the building occupied ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Is occupancy the same as previous Inspection ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c. Are all systems In service ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
d. Are all fire protection systems the same as last Inspection ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
a. Is the building completely sprinklered ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
f. Are all new additions and building changes properly protected ? - - - - - - - - - - - - - - - - - - - - - - - - - - - -
9. Is all stock or storage properly below sprinkler piping ? -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
h. Was property free of fires since lost Inspection ? (Explain any fire on Page 2) . . . . . . . . . . . . . . . . . . . . . . . .
1. In areas protected by wet systems, Is building properly heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected agalnstthe cold ?
2. CONTROL VALVES (See Section 17)
.a. Are all sprinkler system main control valves open 7 - - - - - - - - - - - - - - - - - - - - - - - - ----- - - - - - -
b. Are all other control valves In proper position ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c. Are all control valves In good condition and seated or supervised ? - - - - - - - - - - - - - - - - - - - - - - - - - - -
3. WATER SUPPLIES (See Section 18)
a. Was a water flow test preformed and were the results satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - -
4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS
a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? - - - - - - - - - - - -
b. Are Fire Department Connections In satisfactory condition, couplings free, caps In place and check valves tight Z - - - - - - - - - - -
5. WET SYSTEM (See Section 13)
a. Are cold weather valves open or closed as necessary ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Have antifreeze systems been tested and left In satisfactory condition ? Temp. ? — - - - - - - - - - - - - - - - - - -
c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? - - - - - - - - - - - - - - - - - - - - -
6. DRY SYSTEMS (See Section 14) . . . I
a. Are dry valve(s) In service and In good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Are pressure and priming water levels normal ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c. Is air compressor,in good condition ? - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - -
d. Were low points drained during fall and winter Inspections ? - - - -- - - - - - - - - - - - - - - - - - - - - - - - - -
a. Are Quick- opening devices In service ? - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - -
f. Has piping been checked for stoppage within the past ten (10) years ? - - - - - - - - - - - - - - - - - Nc-�_a —eo I;-0 .
g. Has piping been checked for proper pitch within the past five (5) years ? - - - - - - - . . . . . . . . . .
h. Have dry valves been trip tested satisfactorily as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1. Are dry valves adequately protected from freezing ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1. Are valve house and heater conditions satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7. SPECIAL SYSTEMS (See Section 16)
a. Were valves tested as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Were all heat -responsive systems tested and were the results satisfactory ? - - - - - - --- - - - - --- - - - - - - - - - -
c. Were supervisory features tested and were the results satisfactory ? - - - - - - - - - --- - - - - - - - - - - - - - - - -
&ALARMS
a. Is the water motor and gong test satisfactory ? - --- - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - -
b. Is the electric alarm test satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c. Is the supervisory alarm service test satisfactory ? Monitoring Co. Ph.: Code:
9..SPRINKLERS - PIPING
a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or loading ? - - - - - - - - - - ----- - - - - -
b. Are all sprinkler heads less than fifty (50) years old? Head Manufacturer: Date of head
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
Fire Protection Contractors
since 1930
LER COMPANY
3434 Rrst Ave. Scx, Seatille, WA 98134, 206. 622-4656
LEVEL M
W2 Calfilmillb WW, LopgWele, WA 98M, 3W. 425. MO
Fire Sprinkler Inspection Report
Page:W2
9. SPRINKLER PIPING Continued)
YES
N.A.
NO
c. Are extra sprinkler heads readily available.,? - - - - - - - - - - - - -
- -
------------------
d. Is condition of piping, drain valves, check valves, hangers, pressure gauge a, open sprinklers, and s4alners sattfactory ? - - - - - -
-- - -
7;�O
—
a. Are all sprinklers of proper temperature rating? - . . . . .
. . . . . . . . . . . . . . . . . .
f. Are portable fire extinguishers In good condition ? - - - - - - - - - - -
- - - --- - - - - - - - - - - - - - -
- - -
g. Is hand hose on sprinkler systems satisfactory ? . . . . . . . . . . .
.
.10. Date Dry System Piping last checked for stpopage -- - - - - - - - - - -
- - - - - - - - - - - - - -
- - -
11. Dry System Piping last for
14P-4�0
Date checked proper pitch -- - - - - - - - - -
- - - - - - - - - - -
12. Date Dry Pipe,Valve last trip tested -----------------------------
13. Wet systems: Number: Make / Model / Year: 15 (A,�'Or
14. Dry Systems: Number: Make I Model I Year:
15. Accelerator: Make / Model Year: A
'r
16. Special Systems:, Number: Type:
14.
Make / Model Year
Condition
17. CONTROL VALVES
a. City Connecti on Control Valves - - - - - -
.b.Tank Control Valves - - - - - - - - -
c. Rump Control, valves - - - - - - - - -
Sectional Control Valves - - - - - - - - -
a. System Control Valves - ; - - - - - - -
18. WATER FLOW TEST
a. Water Pressure Source :AC<, 07ank, 0 Fire Pump, Water Flow Test taken ? — If not, reason:
Test Pipe Location
Size Test Pipe
Pressure Before
Flow Pressure.
Pressure After
15; 151,
7 CN
19. Explanation of any "No" answers:
20. Recent changes In building occupancy or fire protection equipment:
21. Adjustments or corrections made:
22. Desirable Improvements:
23. Was building owner / representative been notified of any deficiency to the fire protection system? 0 Yes 0 No, Person notified:
If answer is "No",explain:
24. Inspector's Signature: Witness (property,owner / lessee) and date:
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
_771 I"
Fire Protection Contractors since 1930
VIKING AUTOMATIC SPRINKLER COMPANY 3434 First Ave. So., Seattle, WA 98134, 206.622.4656
WA.: VI-KI-NA-S373NT LEVEL M 602 California Way, Longview, WA 98632,360,425.7620
Fire Sprinkler Inspection Report Page:lof2
0%eu�
.3
REPORT TO:
'Es 1Z
JOB NO. DATE
STREE T:
C->
BLDG./ LOCATION:
61T
CITY/ STATE:
I N S P E 0 R
1.GENERAL
a. Is the building occupied ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _7
b. Is occupancy the same as previous Inspection ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c. Are all systems In service ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. Are all fire protection systems the same as last Inspection ? - - - - - - - - - - - - - - -- . . . . . . ..
a. Is -the building completely sprinklered 11� - - - - - - - - - - - - - - - . . . . . . . . . . . .. . . . .
f. Are all new additions and building changes properly protected.?., - - -
A,
g Is all atock'c��ita' ge:Pt—ogefly 6elow4prinkler piping ?
h. Was property free of fires since last Inspection ? (Explain any fIre*on Page 2) . . . . . . . . . . . . . . . . .
1. In areas protected by wet syste ms, Is building properly heated, I.e.: blind attics, perimeter areas, and are all exterior openings protected against
2. CONTROL VALVES (See Section 17)
a. Are all sprinkler system main control valves open ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Are all other control valves In proper position ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
C.4�e all control valves In good condition and sealed or supervised ? - - - - - - - - - - - - - - - - - - - - - - -
3. WATER SUPPLIES (See Section 18)
a. Was a water flow test,preformed and were the results satisfactory ? - - - - - - - - - - - - - - - - - - - - - - -
4. TANKS, PUMPS, & FIRE DEPARTMENT CONNECTIONS
a. Are fire pumps, gravity tanks, resevoirs and pressure tanks In good condition and properly maintained ? - - - - - --- - - - -
b. Are Fire DepaIrtment Connections In satisfactory condition, couplings free, caps In place and check valves tight t . . . . . . .
t5.WETSYSTEM (SeeSectIon13)
a. Are cold weathervalves; open or closed as necessary ? . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Have antifreeze systems been tested and left In satisfbctory condition ? Temp. ? — - - - - - - - - - - - - - -
c. Are alarm valves, water flow Indicators and retard chambers In satisfactory condition ? - - - - - - - - - - - - - - - - -
6. DRY SYSTEMS (See Section 14)
a. Are dry valve(s) In service and in good condition ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. Arej��essure and priming water levels normal ? - - - - - - - - - - - - - - - - - - - - - - - - -
c. Is air compressor In good condition ? - - - - - -
d. Wirt lovip6l6ts'dial6ad auihrijiili��nid terlinspections ? - - - -- - - - - - - - - - - - - - - - - - -
a. Are Oulck- opening devices In service ? - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - -
f. Has �Iping been checked for stoppage within the past ten (10) years ? - - - - - - - - - - - - - - - N
9. Has piping been checked for proper pitch within the past five (5) years ? - - - - - - - -- - - - - - - Njev-)_
h. Have dry valves been trip tested satisfactorily as required ? - - - - - - - - - - - - - - - - - - - - - - - - - -
1. Are dry valves adequate I y protected from freezing ? - -- - - - - - - - - - - - - - - - - - - - - - - - - - -
1. Are valve house and heater conditions satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7. SPECIAL SYSTEMS (See Section 16)
a. Were valves tested as required ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Were all heat -responsive systems tested and were the results satisfactory ? - - - - - - - - - - - - - - - - w -
c. Were supervisory features tested and were the results satisfactory ? - - - - - - - - - - - - - - - - - - - - - - -
8. ALARMS
a. Is the water motor and gong test satisfactory ? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
b. Is the electric alarm test satisfactory ? - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - -
c. Is the supervisory alarm service test satisfactory? MonitoringCo. Ph.. Code:
9. SPRINKLERS - PIPING
a. Are all sprinkler heads In good condition, not obstructed and free from corrosion or loading ? - - - - - - - - - - - - - -
b. Are all sprinkler heads less than fifty (50) years old ? Head Manufacturer : Date of head :,;;�
1�11�ITE- VIKING COPY YELLOW INVOICE COPY , PINK- FIRE DEPARTMENT. COPY GOLD: BUILDING COPY
T7
j
Fire Protection Contractors since 1930
NO, I I
VIKING AUTOMATIC SPRINKLER COMPANY 3434 Rist Ave. So., SeatUe, WA 98134, 206. 622. 46W
WA.: V1-#GLM-S373NT LEVEL M 602 Caffilwfala Wgy, LaWL46w, WA SSW, 360.425. 7620
Fire Sprinkler Inspection Report Page:W2
9. SPRINKLER / PIPING (Continued) YES N.A. NO
c. Are extra sprinkler heads readily available ? - - - - - - - - - - - ---- - - - - - - - - - - - - - - - - - - - - - -
d. Is condition of piping, drain valves, check valves, hangers, pressure gauges, open sprinklers, and strainers sadfactory ? - - - - - - - - -
e� Are all sprinklers of proper temperature rating? . . . . . . . . . . . . . . . . . . . . . - - - - - - - - - - - -
f. Are portable fire extinguishers In good condition ? . . . . . . . . . ... . . . ..... . - - - - - - - - - - - - - - - -
g. Is hand hose on sprinkler systems satisfactory ? - - - - - - - - - - - - - -- - - - - - - - - --- - - - -- - - - - -
10. Date Dry System Piping last checked for
steopage -- - --- - - - - -- - - - - - - - -- - - - - - - I --- - - - -
11. Date Dry System Piping last checked for proper pitch -- - - - - - - - - - - - - - - - - - - - - - - - - t4
'12. Date Dry Pipe Valve last trip tested -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
13. Wet systems: Number: Maki I Model I Year- SlAmalt 6>7
14. Dry Systems: Number: Make I Model I Yeanz E pool
15. Accelerator: Make/ Model /Year:-
16. Special Systems: Number: Type:
- - -M. a-'ke`/- -Model / Year Condition
17,1, CONTROL VALVES
a. City Connection Control Valves - - - - - -
b. Tank Control Valves - - -- - - - - - -
c. Pump Control Valves - - - - - - - - -
dASectional Control Valves - - - - - - - - -
a. System Control Valves - : - - - - - - -
Number
Type
Open
Yes No
Secured
Yes No
C
Yes No
Sign
Yes No
Condition
QC.,)
I& WATER FLOW TEST
a. Water Pressure Source :.W6ft'y, 137ank, E3 Fire Pump, Water Flow Test taken ?- Knot, reason:
Test Pipe Location
Size Test Pipe
Pressure Before
Flow Pressure
Pressure After
-7
19. Explanation of any "No" answers:
20. Recent changes In building occupancy or fire protection equipment:
21. Adjustment's or cor4ctions* made:
22. Desirable Improvements:
CNTC" -N,.M.,P4 T)p�:;� KO-r —reA-Lt�— N 1C--Lk`LL, E L-c�
-7
23. Has building owner / representative been notified ofany deficiency to the fire protection system? 0 Yes 0 No, Person notified:
It answer Is "No",explain:
24. Inspector's Signature: Witness (property owner lessee) and date:
WHITE: VIKING COPY YELLOW: INVOICE COPY PINK: FIRE DEPARTMENT COPY GOLD: BUILDING COPY
elING. i, Fire Protection Contractors since 1930
3 AUTOMATIC SPRINKLER COMPANY 3434 FirstAve. So., Seattie, WA 98134,206. a2.4656
WA.: VI-KI-NA-S373NT LEVEL X W2 Calffbmia Way, Lonpiew, WA 98M, 360. 425. 7620
COMPANY- JOBNO.:LL),�,l 3868 DATE: )0�14/113
STREET:. At ZS U.) Z zlv.� ST PROPERTY NAME I LOCATION:
CITY / STATE: ab 04 0&-)�'k*�)
DRYPIPE VALVE TEST
.1. Valve description
a. Size
b. Make
c. Model
d. Year of Mfg.
2. Control Sprinklers in
3. Pressure (Lb) before tests:
r '
b. Wate'r
4. Control Valve
a. Wide open
b*. No (No.of turns to open)
5. Operated at':
a. Air pressure (Lb)
b. Time (Min.,Sec.)
6. Operation Indicated:
a. Satisfactory
b. Partially satisfactory
c. Failed
7. Reason for.'
a. failure
b. partially s-atisfactory
8. Valve reset dry? (yes/no)
9. Condition:
a. Interior of body
b. Water for test p.ipe
�Ivc. moving Darts
e. Rubber facing
10.Alarms operated? (yes/no)
11. Inspector's Test trip time (Sec.)
12.Quick Opening Devices:
a. Make
b. Model.
c. Year
13.0perationindictated:
a. Satisfactory
b. Failed to shut off
14-List of repairs.made:
4a
d"Atle of 'rSon performin
1pe� g test
DRY
PIPE VALVES
No.1
No.2
No.3
IF -'L
DT
9 FA
GD e,-o 0
Q/7
QUICK OPENING DEVICES
) and date signed.
Tier Two Emergency and Hazardous Chemical Inventory
Specific Information by Chemical
Revised April 1999
Community Right -to -Know ID #:
(REQUIRED INFORMATION)
tf R K00000 q1 7
Page 1 of
Facility Identification UBI/DOR#:
Name De"ex cle-r-tic e—&,^P- 'ejod.01 ;,r \ L� gg,gaw,q
it
Owner/Operator Name
ame c ;e,,, LV,�.( o-Sever Qslr.-.,�-Phone (142 S* `7_24i- 7 7C
- V
Addres 2::�7 Z !;- Opt otota'-s tve..e
Address :3 C70 6-- Alo rf'K 0 Qr� Ve-
.Aer
city 14/,,,Cl County 4�"n 0 bo fALS P��_State L4-,# Zip
Latitude Longitude
SIC Code 1401TW-1 Dun Bradstreet No[= FEE] E=
City ocft a A C/_f State Zip a?_j�j
FAX (qt sr 1 7(9 S,6 EMAIL:.jje,,,,,dp CpV,
Emergency Contact
Name Ro /4 an a4 e V-
,get- Title G P-Aer.1
Phone ( lijs- Z 7,e4 - 7;76 p 24-hr. Phone (2c?(, I C,?-_
Name 5j4e_&A_.1 0"'Phy, Title
. ..................... ... ! ...... . . ... 7 ... . ........ ...............
Phone ("r %2z��Zct_ 24-hr. Phone (?.oC.
Mailing Address Name 0 L// r- L�, 5
Must be included / y
if different from Street .9'3 ZA �—_ 992Mej415
Facility Address PO Box City State aA Zip'
Important. Read all instructions before completing form.
I
Reporting Period: From January 1 to December 31, L
JL��Ch eck if information below is identical to the
information submitted last year.
Chemical Description
Physical and Health
Hazards
tcheck all that apply)
INVENTORY
Storage Codes Storage Locations
Container (Non -Confidential)
TYPe Pressure Temperature (Please Prim)
CAS Trade Secret El
Chem. Nam
EHS Name
OFire
D Sudden Release
of Pressure
®R Reactivity
0 Immediate (acute)
ElDelayed (chronic)
Fo F3 jMax. Daily
Amount (code)
---]Avg. Daily
Fol -3
Amount (code)
No. of Days
On -site
E:
ord :vx proc..rx-s cLrec,
_C2 f r A:6nA . ............ ......
—1
Chock all ED 5�1 [__1 ED
that apply Pure Mix Solid Liquid Gas EHS
0
T,.d
CAS I / 1010 qFyT_1 F6-121[ e Secret
D
Chem. Nam
r_P9k,e$f 0r7,qj4er-,s
FIFire
E]Sudden Release
of Pressure
Reactivity
F�;l
I rN 1 Immediate (acute)
DDelayed (chronic)
LO--W:]Max. Daily
Amount (code)
-F-]Avg. Daily
6 /
Amount (code)
12-KKINo. of Days
On -site
C
—
—
Al
51 C? 0 a -ro it ie- V r
.............................. ............... ...... . .... . . ................... . .
CarvLee, c!) -0
.
—
EHS Name
Check all
that apply Pure Mix I Solid Liquid Gas EHS
.
......... . ... ............... ..................... ....... . .................... ...................
.. ..........................
CAS Trade Secret
Chem. Nam -ev% e
DFire
E]Sudden Release
of Pressure
Reactivity
Immediate (acute).
Delayed (chronic)
[�; �?_ Max. Daily
Amount (code)
FOF -]Avg. Daily
Amount (code)
- No. of Days
[3�t�
On -site
Slered io
EHS Name
Chock all
that apply Pure Mix Solid Liquid' Gas EHS
CerillIcation (Read and sign after completing aH sections)
I ccrti6, under penalty of law that I have personally examined and am familiar with tile inforniation submitl �i pays_�Ihni and that based on my inquiry of these
Ite d Icte
uals responsible for oblainingthc information, I believe that the submitted iinforniation is tru,(�14__an cot
VM P, c
T_ cb�-l"a''g DL�,n-,,&7- I 1<1
Name ind offilcial title of owner/operator's authorized representative SiViature Date SiVied
OPTIONAL ATTACHMENTS
ElI
have attached a site plan
ha%,e attached a list of site coordinate
albbmiations
ElI have attached a description of dikes and
other safeguard measures
SNOHOMISAbb., Set-yh?g �qrie.riEd,mpnds
Mbuntlak� !�rraceand
) T I R E
,he Town of Woodway.
DISTR k'T www.FireDistrictl.org,
LOCATION: 23725 Edmonds Way
BUSINESS NAME: Olympic View Water District
MAILING 23725 Edmonds Wy
ADDRESS: Edmonds 98026
12425 Meridian Ave S
Everett, WA 98208
Phone (425) 551-1200
Fax (425) 551-1272
PHONE: 4257747769
FIRE PREVENTION
INSPECTION REPORT
0 EDMONDS
0 BRIER
E]WOODWAY
[I MOUNTLAKE TERRACE
[I UNINCORPORATED
FREQUENCY
STATION& SHIF'*l
731
20 B
I
SCHEDULED
DUE 0
rDATE
LIFIR 1, 594
8005
,I HOME PH
BUSINESS OWNER: qi;-206646 ACTIVE
Olympic View Water 5
URRENT
KEY ACCESS-2: IT
HOME PHONE:
EMERGENCY-1:
HOME PHONE=t!.��
;? [ BUSINESS
c, LICENSE
INITIAL INSPECTION DATE
DN CONTACTED:
NAME OF INSPECTOR:
FIRE FA 2J% IC -A q-11 FE
SYSTEMS: A U
HAZARDS FOUND AND LOCATIONS COMMUNICATIONS
2
2
3
3
4
4
5
5
6
6
7
7
I AGREE TO CORRECT THE ABOVE VIOLATION(S) IN THE NEXT 30 DAYS X
I st RE -INSPECTION
DATE DUE:
2nd RE -INSPECTION
DATE DUE:
EXTENSION
GRANTED TO:
FINAL RE -INSPECTION
DATE DUE:
VIOLATIONS
CITED:
PERSON
CONTACTED:
PERSON
CONTACTED:
PERSON
CONTACTED:
I
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
RETURNIRECEIPT
RECEIVED
6
4
18
4 18
DATE:
DISPOSITION:
7
\1 LETTER NEEDED F] YES NO
LETTER NEEDED [] YES NO
8
FIRE DEPARTMENT COPY
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
January 3, 2012
Please verify and correct the following information:
Name of Company (DBA):
Olympic View Water District
Edmonds Location :
23725 Edmonds Way
In conformity with the
terms of the International
Fire Code, apl5licatid-n—is
Storage —arid use of Class -I -and III flammable and/or
hereby made to store, use
combustible liquids and hazardous materials sodium
or maintain the following
hypochlorite & sodium fluoride.
activity, storage or pro-
cesses:
23?25 -Edmonds M-.-gig
Mailing Address:
Edmonds, WA 98026
EFD LIFIR #:
(for office use)
59400008135
Your Signature
Your Name (print)
- ir
1) uAiPA V
Your Title
010-ex.,ft2r�'oAd-5
Please make corrections, attach $40 payable to the City of Edmonds and mail to:
Fire Marshal
Department of Fire Prevention
121-5 th Avenue North
Edmonds, WA 98020
FOR OFFICE USE ONLY
Rec'd
(�' ho
Check#
.35-qt
APPLICATION FOR PERMIT
FOR MATERIALS OR PROCESSES
March 7, 2011
Please verify and correct the following information:
MAR 2 4 PA
EDMONDS FIRE DEPT.
MIAMI
Name of Company; DBA
Olympic View Water District
Edmonds Location
23725 Edmonds Way
In conformity with the terms of
Storage and use of Class 1, 11, and III flammable and/or
the International Fire Code,
combustible liquids and hazardous materials sodium
application is hereby made to
hypochlorite & sodium fluoride.
store, use or maintain the
following activity, storage or
processes:
ox I-P
Mailing Address:
23725 Edmonds Wy.
Edmonds WA 98026
EFD UFIR
5940000813005
(for office use)
Your Signature
Your Name (print)
57--e O-e- 0 0,j10/7 14-1
Your Title
Please make corrections, attach $40 payable to the City of Edmonds, and mail to:
Fire Marshal
Department of Fire Prevention
121 _5th Avenue North
Edmonds, WA 98020
;0
CITY OF EDMONDS
DEPARTMENT OF FIRE PREVENTION
PERMIT
January 1, 2011 594-000-0813-005 December 31, 2011
Date of Issue UFIR Number Date of Expiration
I This PERMIT is issued to: I Olympic View Water District
I located at: 123725 Edmonds Way I Edmonds, WA I
I To engage in the business, occupation or pr cess of: I I
And shall constitute permission to maintain, store, use or handle materials or to conduct
process which produce conditions hazardous to life or property or to install equipment used in
connection with such activities as follows:
Storage and use of Class 1, 11, and III flammable and/or combustible liquids and
hazardous materials sodium hypochlorite & sodium fluoride.
I Allowed Occupant Load: I --
Pursuant to the provisions of the International Fire Code, any violation of the Code may be
grounds for the revocation of this.PERMIT.
This permit does not take the place of any
license required by law and is not
transferable. Any change in the use or
occupancy of premises shall require a new
permit.
rtment of Fire PreVention
This Permit Must Be Posted At All Times in The Premises Identified Above
City of Edmonds Community Development Code 19.25.020
Wesffall, John
From: Westfall, John
Sent: Thursday, May 19, 2005 8:32 AM
To: 'Roger Eberhart'
Subject: RE: International fire code
Roger:
Yes -both of these are corrosive solutions, aren't they? Permitted quantities are over max
allowable quantity of 55 gallons. You have an existing occupancy permit (per IFC 105) for
flammable/combustible storage. I should add those two to your existing permit. Multiple
permitted hazards can be combined at the same location.
What else would you like to know?
John
----- Original Message -----
From: Roger Eberhart [mailto:RogerE@ovwater.com]
Sent: Thursday, May 19, 2005 7:45 AM
To: westfall@ci.edmonds.wa.us
Subject: International fire code
John,
Do you have available an international fire code? We need to know about permit
requirements for sodium hypochlorite and sodium fluoride storage. Our reference is to
section 105. Can you help?
Roger C. Eberhart,
General Manager
Olympic View Water
425-774-7769
PE
and Sewer District
1
Hazardous Substances (Superfund)
Page I of 18
Investigate REGULATIONSI Federal Regulatory Program Lists
Pottution Topics
List: Hazardous Substances (Superfund)
Description
� Toxic Chemical Releases The Comprehensive Environmental Response, Compensation, and Liability Act
� Lead Hazards (CERCLA) created the Superfund Program to clean up uncontrolled or
� Superfund abandoned hazardous -waste sites and to respond to accidents, spills, and other
[=W OUT:# emergency releases of pollutants and contaminants. Section 101 defines a list
ftfr4t, , Ml=
of hazardous chemicals for which the U.S. EPA must establish regulations.
� Smog and Particulates Releases of CERCLA hazardous substances in amounts greater than their
0 Hazardous Air Pottulants "reportable quantity" must be reported to the National Response Center and to
state and local government officials.
� Ctean Water Act Hazardous substances identified in CERCLA include all chemicals on the
0 Watershed Indicators following regulatory lists:
1. Clean Air Act list of hazardous air pollutants (HAPs)
2. Clean Water Act list of hazardous substances and priority pollutants
k Animal Waste 3. Solid Waste Disposal Act list of hazardous wastes
4. Toxic Substances Control Act list of imminent hazards
"I ! r � I Reference
0 Community Center EPA, Office of Solid Waste and Emergency Response. LIST OF LISTS:
0 En Espahat Consolidated List of Chemicals Subject to the Emergency Planning and
Community Right -To -Know Act (EPCRA) and Section 112(r) of the Clean Air
Act: CERCLA Hazardous Substances.
http_-//)ALww.epa-.gpv/geppg/pqbs/title3.p-df.
� Chemical Profiles
k Health Effects
k Regulations
ZIP TO YOUR COMMUNITY
SEARCH SCORECARD
F7777
List of Chemicals
Note: For your convenience, these data are also available as a CSV file. Click
here to download.
Chemical Name
ACENAPHTHENE
ACENAPHTHYLENE
ACETALDEHYDE
ACETAMIDE
ACETIC ACID
CAS Registry
Number (or EDF
Substance ID)
83-32-9
208-96-8
75-07-0
60-35-5
64-19-7
ACETIC ACID,-L2,-4,5-TRICHLOROPHENOXY)--,-!-
METHYLPROPYL ESTER
61792-07-2
ACETIC ACIDI-(2,-4,5-TRICHLOROPHENOXY)-,-Z-
2545-59-7
BUTOXYETHYL ESTER
ACETIC ACID,-(2,4,5-TRICHLOROPHENOXY)-,-Z-
ETHYLHEXYL ESTER
1928-47-8
ACETIC ACID, 2, -TRICHLOROPHENOXY)--,.
-L -4,5
COMPD. WITH I-AMINO-2-PROPANOL (1:1)
1319-72-8
ACETIC ACID,-(2,-4,5-TRICHLOROPHENOXY)--,
http://www.scorecard.org/chemical-groups/one-list.tcl?short—list—name=hs 5/19/2005
Hazardous Substances (Superftind)
Page 15 of 18
RESORCINOL
108-46-3
LRS)-SEC-BUTYLAMINE
13952-84-6
SACCHARIN
81-07-2
SAFROLE
94-59-7
SEC -BUTYL ACETATE
105-46-4
SELENIOUS ACID
7783-00-8
SELENIUM
7782-49-2
SELENIUM COMPOUNDS
SBP500
SELENIUM OXIDE
7446-08-4
SELENIUM SULFIDE
7446-34-6
2-SELENOUREA
630-10-4
SILVER
7440-22-4
SILVER COMPOUNDS
SDOOOO
SILVER CYANIDE
506-64-9
SILVER NITRATE
7761-88-8
SODIUM
7440-23-5
SODIUM ARSENATE (ASH304.XNA)-
7631-89-2
SODIUM ARSENITE
7784-46-5
SODIUM AZIDE
26628-22-8
SODIUM BICHROMATE
10588-01-9
SODIUM BIFLUORIDE
1333-83-1
SODIUM BISULFITE
7631-90-5
SODIUM CHROMATE
7775-11-3
SODIUM CYANIDE
143-33-9'
SODIUM DODECYLBENZENE SULFONATE
25155-30-0
6SRACIOM MMUO
7681-49-4
ODIUM HYDR05-ULEIDE----
16721-80-5
7681-52-9
SODIUM METHYLATE
124-41-4
SODIUM NITRITE
7632-00-0
SODIUM PHOSPHATE, TRIBASIC
7601-54-9
SODIUM SELENITE H203SE.2NA)-
10102-18-8
STREPTOZOTOCIN
18883-66-4
STRONTIUM CHROMATE
7789-06-2
STRYCHNINE
57-24-9
STYRENE
100-42-5
STYRENE OXIDE
96-09-3
SULFOTEP
3689-24-5
SULFUR CHLORIDE (MONO)
10025-67-9
SULFURIC ACID
7664-93-9
SULFURIC ACID (FUMINGI
8014-95-7
2
,4,5-T
93-76-5
2,-4,5-T AMINES
6369-96-6
2,4,5-T ESTERS
93-79-8
2,4,5-T SA
13560-99-1
TEPP
107-49-3
http://www.scorecard.org/chemical-groups/one-list.tcl?short—list—name=hs
5/19/2005
Material Safety Data Sheet
Page I of 5
Material Safety Data Sheet
acc. to OSHA and ANSI
Printing date 07/14/2003 Reviewed on 06/06/2003
1 Identification of substance:
0 Product details:
0 Product name: Sodium chloride. 0.1N Standardized Solution
0 Stock number: 35616
0 Manufacturer/Supplier:
Alfa Aesar, A Johnson Matthey Company
Johnson Matthey Catalog Company, Inc.
30 Bond Street
Ward Hill, MA 01835-8099
Emergency Phone: (978) 521-6300
CHEMTREC: (800) 424-9300
Web Site: www.alfa.com
• Information Department: Health, Safety and Environmental Department
• Emergency information:
During normal hours the Health, Safety and Environmental Department. After normal
hours call Chemtrec at (800) 424-9300.
2 Composition/Data on components:
0 Chemical characterization:
Descripti
LonCAS#)
Sodium chloride (CAS# 7647-14-5), <0.6%
Water (CAS# 7732-18-5), Balance
3 Hazards identification
• Hazard description: - Not applicable
• Information pertaining to particular dangers for man and environment
Not applicable
• Classification system
• HMIS ratings (scale 0-4)
(Hazardous Materials Identification System)
Health (acute effects) = 0
Flammability = 0
Reactivity = 0
4 First aid measures
• General information No special measures required.
• After inhalation Seek medical treatment in case of complaints.
http://www.alfa.com/CGI-BIN/LANSAVY'EB?WEBEVENT+LO9072835104704005BAA05M+ALF... 5/19/2005
Material Safety Data Sheet
0 After skin contact Generally the product does not irritate the skin.
Page 2 of 5
0 After eye contact
Rinse opened eye for several minutes under running water. If symptoms persist,
consult a doctor.
0 After swallowing Seek medical treatment.
5 Fire fighting measures
0 Suitable extinguishing agents
Product is not flammable. Use fire fighting measures that suit the surrounding
fire.
0 Protective equipment: No special measures required.
6 Accidental release measures
0 Person -related safety precautions: Not required.
• Measures for environmental protection:
Do not allow material to be released to the environment without proper
governmental permits.
• Measures for cleaning/collecting:
Absorb with liquid -binding material (sand, diatomite, acid binders, universal
binders, sawdust).
0 Additional information:
See Section 7 for information on safe handling
See Section 8 for information on personal protection equipment.
See Section 13 for disposal information.
7 Handling and storag-q
• Handling
• Information for safe handling:
Keep container tightly sealed.
Store in cool, dry place in tightly closed containers.
No special precautions are necessary if used correctly.
• Information about protection against explosions and fires:
No special measures required.
0 Storage
• Requirements to be met by storerooms and receptacles:
No special requirements.
• Information about storage in one common storage facility:
Aqueous solutions are incompatible with alkali and alkaline earth metals and many
reactive organic and inorganic chemicals.
• Further information about storage conditions: None.
8 Exposure controls and personal protection
0 Additional information about design of technical systems:
No further data; see item 7.
Components with limit values that require monitoring at the workplace:
Not required.
0 Additional information: No data
• Personal protective equipment
• General protective and hygienic measures
The usual precautionary measures for handling chemicals should be followed.
• Breathing equipment: Not required.
• Protection of hands: Not required.
• Eye protection: Safety glasses
• Body protection: Protective work clothing.
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Material Safety Data Sheet
Page 3 of 5
9 P'Aysical and chemical pro erties:
0 General Information
• Form: Liquid
• Color: Colorless
• Odor: Odorless
0
• Change in condition
• Melting point/Melting range:
• Boiling point/Boiling range:
• Sublimation temperature / start:
0 Flash point:
Not determined
0 Ignition temperature:
0 Decomposition temperature:
Value/Range Unit Method
0 o C (approx)
100 * C (approx)
Not determined
Not applicable
Not determined
Not determined
0 Danger of -explosion:
Product does not present an explosion hazard.
• Explosion limits:
• Lower:
• Upper:
0 Vapor pressure:
0 Density:
at 20 0 C
• Solubility in / Miscibility with
• Water:
0 10 Stabili and reaptivity
Not determined
Not determined
Not determined
Fully miscible
1 g/cm3 (approx)
• Thermal decomposition / conditions to be avoided:
Decomposition will not occur if used and stored according to specifications.
• Materials to be avoided:
Aqueous solutions are incompatible with alkali and alkaline earth metals and many
reactive organic and inorganic chemicals.
• Dangerous reactions
Reacts with alkali metals
Reacts with alkaline earth metals
• Dangerous products of decomposition: None known.
0 11 Toxicoloaical information
• Acute toxicity:
• Primary irritant effect:
• on the skin: Generally the product does not irritate the skin.
• on the eye: No irritating effect.
• Sensitization: No sensitizing effects known.
• Subacute to chronic toxicity:
Other than potential irritation (see above), no information on illness or injury
to humans from acute or chronic exposure to this product is available.
• Additional toxicological information:
To the best of our knowledge the acute and chronic toxicity of this substance is
not fully known.
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Material Safety Data Sheet
Page 4 of 5
No classification data on carcinogenic properties of this material is available
11 from the EPA, IARC, NTP, OSHA or ACGIH.
12 Ecological information:
0 General notes:
Do not allow material to be released to the environment without proper
governmental permits.
0 13 Disr)osal considerations
• Product:
• Recommendation
Consult state, local or national regulations to ensure proper disposal.
• Uncleaned packagings:
• Recommendation:
Disposal must be made according to official regulations.
• Recommended cleansing agent: Water, if necessary with cleansing agents.
14 Transport information
Not a hazardous material for transportation.
• DOT regulations:
• Hazard class: None
• Land transport ADR/RID (cross -border)
• ADR/RID class: None
• Maritime transport IMDG:
• IMDG Class: None
• Air transport ICAO-TI and IATA-DGR:
• ICAO/IATA Class: None
0 Transport/Additional information:
Not dangerous according to the above specifications.
15 Regulations
0 Product related hazard informations:
Observe the general safety regulations when handling chemicals
0 National regulations
All components of this product are listed in the U.S. Environmental Protection
Agency Toxic Substances Control Act Chemical substance Inventory.
0 Information about limitation of use:
For use only by technically qualified individuals.
0 16 Other information:
Employers should use this information only as a supplement to other information
gathered by them, and should make independent judgement of suitability of this
information to ensure proper use and protect the health and safety of employees.
This information is furnished without warranty, and any use of the product not in
conformance with this Material Safety Data Sheet, or in combination with any other
product or process, is the responsibility of the user.
0 Department issuing MSDS: Health, Safety and Environmental Department.
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Material Safety Data Sheet
0 Contact: Darrell R. Sanders
Page 5 of 5
Contact Alfa Aesar todayl
Catalog sales: 1-800-343-0660 or 1-978-521-6300
Technical Service: 1-800-343-7276
Bulk/Specialty Sales: 1-888-343-8025
ALFA AESAR
26 Parkridge Road
Ward Hill, MA 01835
USA
info@alfa.com
Alfa Aesar is an ISO-9002 certified company.
Fine chemicals for research and development from Alfa Aesar, a Johnson Matthey company
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