Report 2177 PH B110 BFP PM 3-9-22.pdf
PDF 378 KB Posted
- Solicitation number
- FA255024R0003
About this file
This notice provides information regarding a future solicitation for base operations support services at Prospect Harbor Space Force Station in Maine. The Department of the Air Force will release a solicitation in January 2024 seeking a contractor to provide management, maintenance, logistics, security, and other base support services on a government owned, contractor operated basis. The requirement is set aside exclusively for small businesses and will utilize a best value source selection process. Offerors must register in the Procurement Integrated Enterprise Environment system, including the solicitation module, to submit proposals electronically in response to the solicitation when released.
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Text version
(ATTACH ADDITIONAL SHEETS IF NECESSARY)
YES NO
YES NO
YES NO
MATERIALS USED
MAINTENACE & INSPECTION REPORT
(ONE FOR EACH PIECE OF EQUIPMENT)
WILL MATERIALS NEED TO BE ORDERED? HOW LONG IS THE LEED TIME?
EXPLAIN BELOW
HAVE NOT BEEN MET
(BELOW) FOR ADMINISTRATION USE ONLY
DATE IT WILL BE RECEIVED :
PROPER PPE BEING WORN
YES
CONTRACTOR: TECHNICIANS NAME:
LOCATION WEATHERBUILDING NAME or #
CONTRACTOR/SIGNATURE CCI/ SIGNATURE SITE INSPECTOR/SIGNATURE
CONTRACT # ELIN # REPORT NO.
HAVE BEEN MET
DATE:
General Direct Condition Rating
TYPE OF EQUIPMENT MAKE MODEL
WORK DESCRIPTION & PROBLEMS FOUNDS
TIME TO COMPLETE TASK
IS INSPECTION CHECK LIST ATTACHED?
SAFETY REQUIREMENTS
WAS WORK COMPLETED?
IF NO EXPLAIN BELOW
General Direct Condition Rating Notes ( Explain Conditions found for the Rating given above)
N40085-17-D-7201
NO
HOUSE KEEPING COMPLETE
YES
NO
MAXIMO # Work Order #
Backflow Prevention Assembly
Test and Maintenance Report
Property Owner/Agent Prospect Harbor
Lighthouse Point Road
Prospect Harbor, ME
CCI Group, LLC
Property Access Derek McCaslin
(207)620-7172 x111
Owner/Agent Contact
March 09, 2022
526 Western Ave.
Augusta, ME 04430 Water Company
DomesticBldg #110 Date of InstallDevice Manufacturer Model Serial No.Size Type
Gauge Manufacturer Purchase DateModel Serial No.
909M1QTWatts 4335451 1/4"
New Install ?
Type
Location of Assembly Service Type-Class-Use
Next Date DueDate Calibrated
Meter/Acct #
Alarm Company Phone Reference Date/Time OnDate/Time Off
RPZ
CV Assembly
______psi ______psi
CHECK VALVE #1 CHECK VALVE #2
PRESSURE VACUUM
Leaked
R E
P A
IR
S
IN
IT
IA
L
T E
S T
F
IN
A L
T E
S T
Closed tight
Pressure drop across check valve
Closed tight
Leaked
Cleaned
Rubber Kit Disc
Opened at:
Did not open Did not open
Air inlet opened:
REPLACED
O-Ring Seat
Spring
Stem/Guide
Retainer
Locknuts
Other
Cleaned
Rubber Kit Disc
REPLACED
O-Ring Seat
Spring
Stem/Guide
Retainer
Locknuts
Other
Cleaned
Rubber Kit Disc
REPLACED
Diaphragm Seat
Spring Guide
O-Ring
Other
Cleaned
Air Inlet Disc
Inlet Spring
REPLACED
Diaphragm
CV Disc
Spring
Guide
Retainer
O-Ring
Other
Closed Tight Closed Tight
Opened at:
Satisfactory
Check held at:
OR OR OR
CV Assembly RV Assembly
Pressure drop across check valve
Pressure drop across check valve
Pressure drop across check valve
X X
LINE PRESSURE:CONTROL VALVE #2:RESULTS OF TEST: LeakedTight
DIFFERENTIAL PRESSURE
Leaked
FailPass
RELIEF VALVE BREAKER
_______psi
______psi ______psi ______psi
______psi ______psi
______psi
XX
9.0 1.6 4.3
I ACKNOWLEDGE THE CONTROL
VALVES HAVE BEEN LEFT IN THE
OPEN POSITION
Witness to Assembly Test (Print) Witness to Assembly Test Signature Date
APPROVALS
INITIAL
TEST
Certified Tester (Print) Certified Tester # Exp. DateCertified Tester Signature
Exp. DateCertified Tester #
FINAL
TEST
Barry Prescott #135
Barry Prescott #135
Date
DateCertified Tester (Print) Certified Tester Signature
I CERTIFY THAT THIS DATA IS ACCURATE AND RELECTS THE PROPER OPERATION AND MAINTENANCE OF THE ASSEMBLY
1990NEWWA 8/26/2024
8/26/20241990NEWWA
3/9/2022
3/9/2022
Print Date: 3/30/2022 Copyright 2002-2020 Life Safety Inspector, OnSite Software
Barry Prescott #135
200000047508Inspection Ref:
Conducted by:
Report of Inspection/Test
Property Owner/Agent
526 Western Ave.
Augusta, ME 04430
CCI Group, LLCProspect Harbor
Lighthouse Point Road
Prospect Harbor, ME
Annual Backflow Prevention Assemblies
Derek McCaslin
(207)620-7172 x111 Print Date: 3/30/2022
03/09/2022
Equipment Summary
Site
Description
Inspected Unable to
Inspect Serviced
Repaired Failed
%Qty%Qty%Qty%QtyQty
Backflow Prevention Assemblies Valve
RPZ (Reduced Pressure) 2 2 0 0100.0% 0.0% 0.0% 0 0.0%
Print Date: 3/30/2022 Copyright 2002-2020 Life Safety Inspector, OnSite Software
| DATE: 3/9/2022 |
| TYPE OF EQUIPMENTRow1: Backflow preventer |
| MAKERow1: Watts |
| MODELRow1: 909M1QT |
| TIME TO COMPLETE TASKRow1: .5 |
| CONTRACTOR: Dean & Allyn, Inc. |
| TECHNICIANS NAME: Barry Prescott |
| LOCATIONRow1: Prospect Harbor |
| BUILDING NAME or Row1: #110 |
| WEATHERRow1: Cool/overcast |
| General Direct Condition RatingRow1: Green + |
| General Direct Condition Rating Notes Explain Conditions found for the Rating given aboveRow1: |
| WILL MATERIALS NEED TO BE ORDERED HOW LONG IS THE LEED TIME EXPLAIN BELOW: |
| MATERIALS USEDRow1: |
| DATE IT WILL BE RECEIVED: |
| CCI SIGNATURERow1: |
| ELIN N4008517D7201: F002AQ |
| REPORT NON4008517D7201: 2177 |
| REPORT NOWork Order: |
| MAXIMO Row1: |
| Work Order Row1: |
| REPORT NORow3: |
| Text1: Annual backflow preventer test. Replaced leaking first check valve assembly |
| Text2: |
| Check Box3: Yes |
| Check Box4: Off |
| Check Box5: Off |
| Check Box6: Yes |
| Check Box7: Yes |
| Check Box8: Off |
| Check Box9: Yes |
| Check Box10: Off |
| Check Box11: Yes |
| Check Box12: Off |
| Check Box13: Yes |
| Check Box14: Off |
File details come from the government source that posted it. Updated .