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Survey of Location Name:
*
Location type
*
Please Select
Apartment - Garden Style
Apartment - Mid Rise (5 Stories +)
Apartment - Mixed Used
Commercial - Hospitality / Hotels
Commercial - Industrial/Warehousing/Manufacturing
Commercial - Office
Commercial - Restaurant - Chain
Commercial - Restaurant - Family Owned
Commercial - Retail
Commercial- Bank
Estate
Gas Station
Government - City / County / State
Homer Owners Association - HOA
Medical - Hospital / Clinic / Recovery
Military - Housing / Base Facilities
Mobile Home Park - MHP
School - K-12 / College / Trade
Location Address:
*
City
*
State/Region
*
Postal code
*
Bill To Name: Management Co/Owner Name
*
First name
*
Last name
Phone number:
*
Email:
Fire Extinguisher
Date of Last Annual Ext:
Month
/
Day
/
Year
Type of Building:
Select One:
Past Due
Recharge
Rehang
Fire Alarm System
Date of Last Annual Alarm:
Month
/
Day
/
Year
Monitoring:
Choose One:
SD
WF
SUPV
HD
Alarm Type:
Panel Type
NAC
Other
Central Monitoring Panel
Cellular
Phone Lines
Fire Sprinkler System
Date of Last Annual Sprinkler:
Month
/
Day
/
Year
Date of Last 5 Year Cert:
Month
/
Day
/
Year
Sprinkler System Type:
Sprinkler Panel Only
Wet Risers
Dry Valve
FDC Type
Wet/Dry Private Hydrants
Fire Pump
Test Loop
GPM
Notes
Notes
Lead Card Submitted by:
Branch
*
Please Select
Chico
Corporate
Desert Mountain Fire
Greater Bay
North Bay
Redding
Rocklin
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