LAFD Fire Protection Equipment Performance Report F-340R Instructions 04-25-2013
LOS ANGELES FIRE DEPARTMENT FIRE PROTECTION EQUIPMENT SUPPLEMENTAL INFORMATION PAGE DATE(S)
of
FIRM OR D.B.A.
TEST SITE ADDRESS: (STREET NUMBER AND STREET NAME)
EQUIPMENT TESTED:
SECTION V – SUPPLEMENTAL INFORMATION- FIRE CODE/BUILDING CODE ISSUES (OPTIONAL) Use this form to report potential fire or building code problems that may require follow-up by a Fire or Building Official. DO NOT use Section V to report systems or equipment DEFECTS pertaining to the address on this F-340R report. When Section V pages are provided, Fire Department personnel shall take the appropriate action to resolve the issue(s), which may include writing a Notice of Violation or contacting the Department of Building and Safety. NOTE: Fire Department personnel shall remove this section prior to forwarding the 340R Fire Protection Equipment Performance Report to the building owner/ owner’s representative. _________________________________________________________________________________________
TESTER’S: NAME
PHONE NUMBER OF TESTING AGENCY:
CERTIFICATE #
EXPIRATION DATE
(STATE)
(ZIP)
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