APP C_REPORT OF INSPECTION TESTING AND MAINTENANCE FORM.pdf
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- Solicitation number
- 75H70625Q00030
About this file
This document is a Report of Inspection, Testing & Maintenance form for Emergency and Standby Power Systems, specifically a Load Bank Test Report template for the Great Plains Area Indian Health Service. The form is designed to document detailed testing of up to three generators (Gen #1, #2, #3), with space to record comprehensive technical data including generator specifications, nameplate data, voltage, amperage, frequency, hours, oil pressure, water temperature, and kilowatt measurements. The report requires technicians to exercise generators with supplemental loads at 50% of nameplate kW rating for 30 continuous minutes and 75% of nameplate kW rating for 1 continuous hour, totaling 1.5 continuous hours of testing.
The form is associated with Solicitation Number 75H70625Q00030, a 100% Small Business Set-Aside procurement for load bank testing and fuel quality testing at Indian Health Service facilities in North Dakota and South Dakota. The contract will be awarded using Lowest Price Technically Acceptable (LPTA) methodology, with contractors required to provide all materials, labor, equipment, and supervision for generator load bank tests. The period of performance is set for 60 days maximum, with testing to be completed within 30 days of the notice to proceed and report submission within 20 days after the final site visit.
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Text version
23.8 Cover Sheet Rev:
Report of Inspection, Testing & Maintenance of Emergency and Standby Power Systems
Type of Inspection/Testing/Maintenance: Load Bank Annual 3−Year Date:
Inspecting Firm:
Street Address:
City: State: Zip:
Phone: Fax:
Inspector Name:
Name of Property:
Street Address:
City: State: Zip:
Phone: Fax:
Designated Representative:
Gen #1 Manufacturer: Gen Model:
Gen Spec: Gen S/N: Gen CPL:
Engine Model: Engine S/N:
Fuel Type: Gasoline Diesel LPG CNG
Rated KW: Rated KVA: Hour Meter:
Gen #2 Manufacturer:
Gen Model:
Engine Model: Engine S/N:
Gen #3 Manufacturer:
Gen Model:
Engine Model: Engine S/N:
ATS #1 Model:
Spec:
S/N:
ATS #2 Model: Spec: S/N:
ATS #3 Model: Spec: S/N:
ATS #4 Model: Spec: S/N:
ATS #5 Model: Spec: S/N:
ATS #6 Model: Spec: S/N:
INSPECTOR’S SIGNATURE:
DATE:
Technician:
(Print)
Signature:
23.8 Rev:
GREAT PLAINS AREA INDIAN HEALTH SERVICE
LOAD BANK TEST REPORT
Facility: Date:
Generator ID#: Gen #1
Model #:
NAMEPLATE DATA
KW: KVA: PF:
VOLTS: AMPS: HZ:
Generator shall be exercised with supplemental loads at not less than 50% of the EPS nameplate kW rating for 30 continuous minutes and at not less than 75% of the EPS nameplate kW rating for 1 continuous hour for a total test duration of not less than 1.5 continuous hours.
Load Rate 50%: 0
Load Rate 75%: 0
(kW) = 50% of Nameplate Data
(kW) = 75% of Nameplate Data
TIME
VOLTS AMPS
HZ
HOURS
OIL
PRESS
WATER
TEMP
KW A-B B-C C-A A B C
Generator ID#: Gen #2
Generator shall be exercised with supplemental loads at not less than 50% of the EPS nameplate kW rating for 30 continuous minutes and at not less than 75% of the EPS nameplate kW rating for 1 continuous hour for a total test duration of not less than 1.5 continuous hours.
PRESS
Generator ID#: Gen #3
Generator shall be exercised with supplemental loads at not less than 50% of the EPS nameplate kW rating for 30 continuous minutes and at not less than 75% of the EPS nameplate kW rating for 1 continuous hour for a total test duration of not less than 1.5 continuous hours.
PRESS
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