D.5 ATTACHMENT 5- EXHIBIT C VASF CORRECTIVE ACTION FORM.pdf
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- Attached to
- J012--Cancelled RFQ 36C26125Q0098
- Solicitation number
- 36C26125Q0098
About this file
This is a corrective action and repairs form (Form AES 10) used for documenting fire protection equipment maintenance in accordance with California Code of Regulations Title 19. The form is designed to track inspection, testing, and maintenance activities, with sections for both property information and contractor/licensed owner information including building details, license numbers, and contact information.
The form contains a table to document specific items requiring attention, with columns for item number, AES Form number, date found, date corrected, and deficiencies/comments. At the bottom, it requires certification signatures from both a building representative and technician to confirm that fire protection equipment has been corrected according to CCR Title 19 Sections 901 to 906 and is fully operable. This appears to be a template form dated September 3, 2013, that would be used to document fire system repairs and maintenance at VA facilities.
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Text version
Corrective Action and Repairs Performed
California Code of Regulations - Title 19 Inspection, Testing, and Maintenance 1 of 1
Property Information Contractor or Licensed Owner Information
Building Name Name Address Address
City St. Zip City License # Phone Contact Person SFM Job # Phone CSLB Misc.
Item AES Form #
Date Found
Date Corrected
Deficiencies and Comments Indicate all equipment, devices and parts that were repaired or replaced
I hereby certify that the fire protection equipment listed above has been corrected in accordance with CCR Title 19 and that the equipment is fully operable.
Building Representative Technician
Signature Signature
Form AES 10 Sept. 3, 2013
File details come from the government source that posted it. Updated .