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\"N/WANZE <br /> Automatic Fire Sprinklers,Inc.® <br /> SYSTEM RECORD OF COMPLETION <br /> This form is to be completed by the system installation contractor at the time of system acceptance and approval.It shall be <br /> permitted to modify this form as needed to provide a more complete and/or clear record. <br /> Insert NlA in all unused lines. <br /> Attach additional sheets, data, or calculations as necessary to provide a complete record <br /> Form Completion Date: 8/31/2020 Supplemental Pages Attached: -- <br /> 1. PROPERTY INFORMATION <br /> Name of property: -- C�A e <br /> Address: <br /> Description of property: -- <br /> Name of property representative: -- <br /> Address: -- <br /> Phone: -- Fax: -- E-mail: -- <br /> 2.INSTALLATION, SERVICE,TESTING,AND MONITORING INFORMATION <br /> Installation contractor: -- <br /> Address: -- <br /> Phone: -- Fax: -- E-mail: -- <br /> Service organization: -- <br /> Address: -- <br /> Phone: -- Fax: -- E-mail: -- <br /> Testing organization: -- <br /> Address: -- <br /> Phone: -- Fax: -- E-mail: -- <br /> Effective date for test and inspection co tract: -- <br /> Monitoring organization: W i G3 <br /> Address: -- - J <br /> Phone: -- Fax: -- E-mail: -- <br /> Account number: YL16 5"Z3�,) Phone line 1: -- Phone line 2: -- <br /> Means of transmission: -- <br /> Entity to which alarms are retransmitted: -- Phone: -- <br /> 3. DOCUMENTATION <br /> On-site location of the required record documents and site-specific software: -- <br /> 4. DESCRIPTION OF SYSTEM SERVICE <br /> This is a: ❑ New system ❑ Modification to existing system Permit number: -- <br /> NFPA 72 edition: Year <br /> 4.1 Control Unit <br /> Manufacturer: -- Model Number: -- <br /> 4.2 Software and Firmware <br /> Firmware revision number: -- <br /> 4.3 AIarm Verification ❑ This system does not incorporate alarm verification. <br /> Number of devices subject to alarm verification: -- Alarm verification set for -- seconds <br /> State Contractor's#: EF20001320 <br />