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Los Angeles Fire Department Form F 340 R 4 2011-2023
TESTING AGENCY: (STREET)
(CITY)
(STATE)
(ZIP)
SYSTEM
CERTIFIED
EQUIPMENT TESTED:
SYSTEM
CERTIFIED
1
YES
NO
4
YES
NO
2
YES
NO
5
YES
NO
3
YES
NO
6
YES
NO
NOTEWORTHY CHARACTERISTIC, SYSTEM DESCRIPTION, PROCEDURES PERFORMED, AND DEFECTS FOUND IN EQUIPMENT TESTED (IF NONE, SO NOTE):
ADDITIONAL INFORMATION ON ATTACHED SHEET(S)
I HEREBY CERTIFY THAT THE FIRE PROTECTION EQUIPMENT LISTED ABOVE HAS BEEN FULLY TESTED IN ACCORDANCE WITH THE CHIEF’S REGULATION NO. 4 OF THE LOS...
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