A22 - AMD 0001 - ME_Fire Inspection and Certificate_2024.pdf

For the best experience, open this PDF portfolio in

Acrobat X or Adobe Reader X, or later.

Get Adobe Reader Now!

http://www.adobe.com/go/reader

Job #: Date:

IMO #: 100% Complete: Yes No

Qty Qty Qty

PORTABLE FIRE EXTINGUISHERS GALLEY HOOD SYSTEM DAMAGE CONTROL LOCKER

CO2 LOW PRESSURE SYSTEM FIRE DETECTION SYSTEM DRY CHEMICAL SYSTEM

CO2 HIGH PRESSURE SYSTEM S.C.B.A. EQUIPMENT MEDICAL O2 EQUIPMENT

HALON/CLEAN AGENT SYSTEM S.C.B.A. COMPRESSOR IMMERSION SUITS

FOAM SYSTEM/FOAM ANALYSIS E.E.B.D. EQUIPMENT FIRE HOSES

FIRE STATION INVENTORY GAS DETECTION SYSTEM WATER MIST SYSTEM

MISCELLANEOUS

Print Date

CERTIFICATE OF INSPECTION

Customer:

Flag / Classification:

Vessel:

Customer Signature

(when applicable)

Hiller Tech Signature

AHJ Signature

The Hiller Companies (and its divisions) herby certifies that the equipment specified below has been inspected, serviced and/or repaired on the date signed. The Hiller Companies

(and all its divisions) does not assume responsibility for the proper functioning of the systems following date of inspection.

THIS IS TO CERTIFY THAT THE EQUIPMENT DESCRIBED HEREIN HAS BEEN INSPECTED AND/OR TESTED AS

REQUIRED IN ACCORDANCE WITH APPLICABLE CODE AND MANUFACTURER RECOMMENDATIONS.

MCOI.XX.XX.01.001

US Army Corps of Engineers 33980147 4/4/2024

USCG ✔

USACE Merritt

✔ 19

✔ 1

✔ 2

4/4/2024

Matt Maniak 4/4/2024

4/4/2024

ST Job #: Service Tech:

System ID: Date:

MS - Manual Fire Boxes HD - Heat Detector B - Bell S - Strobe

H-MS - Halon Manual Station PD - Photo Electric Detector H - Horn PS - Pressure Switch

DSD - Duct Smoke Detector ID - Ionization Detector HS - Horn Strobe

GD - Gas Detector FD - Flame Detector SPK - Speaker

Serial # Location Description Address Manufacturer Device Type Pass Fail Comments

Device Type Abbreviations:

ALARM & DETECTION DEVICE TESTED

MDDT.XX.XX.01.001

Hiller 1242 Executive Boulevard

Chesapeake VA 23320

(757) 549-9123 hillerfire.com

33980147 Matt Maniak engine monitor inc 4/4/2024 engine room HD ✔ pump room HD ✔ pump room HD ✔ galley ID ✔ berthing ID ✔ berthing ID ✔ wheelhouse ID ✔

Location:

Qty of Cylinders: Cylinder Capacity:

Qty of Pilot Cylinders: Cylinder Capacity:

Carried Out Satisfactory Yes No Yes No N/A

7. Checked operation of pressure switch(es)? Quantity: Yes No Yes No N/A

11. Checked other shutdowns? Specify: Yes No Yes No N/A

Set Time: Actual Time:

Quantity: Yes No Yes No N/A

Electric Pneumatic

Room Temperature:

CYLINDERS (additional cylinders to be listed on following supplement, if applicable):

Serial # Manufacturer Stamped

Empty

Full

Required

Agent

Actual

Temperature

°C/°F PSI/BAR Last Hydro

Date Next

Hydro Due

Technician: Date:

Manufacturer:

Space Protected:

19. Checked labeling of system components?

20. Is system sealed and inspection tag attached?

21. Is system armed and ready for use?

9. Checked damper operation?

13. Checked operation of alarms?

15. Checked operation of visual indication?

16. Checked operation of stop valves?

14. Type of Alarms

10. Checked fuel oil pump shutdown?

12. Time Delay

COMMENTS: ANY REMARKS plus EXPLAIN ANY NO Answers

I state that the information on this form is correct at the time and place of the inspection, and that all equipment tested at this time was left in operational condition upon completion of this inspection except as noted in Comments section above.

Customer Name:

17. Checked operation of remote stations?

18. Checked operation of heat actuation?

3. Condition of cylinders (Satisfactory/Unsatisfactory)?

4. Checked for manufacturer recalls?

5. Checked lever/pressure actuation?

6. Checked condition of flex hoses?

8. Checked ventalation shutdown?

GENERAL REQUIREMENTS

1. Disconnect releasing mechanisms?

2. Contents in cylinders checked by weight/ liquid level?

Information on this form covers the minimum requirements of the current edition of 46CFR, appropriate classification requirements, as well as the latest version of the OEM manual (unless otherwise directed by the authority having jurisdiction).

SYSTEM INFORMATION

INSPECTION OF FIXED SUPPRESSION SYSTEM

Service Tech:

Dates of Service

ST Job #:

Vessel Name:

Comments

Technician Information

MFSS.46CFR.XX.01.001

Merritt 4/4/2024 US Army Corps of Engineers Kidde CO2 Room Engine Room

6 50 2 50

1 ✔ ✔

N/A ✔ ✔ 30 30

0 ✔ ✔ 0 ✔ ✔ 2 ✔ ✔

1497853 kidde 122 172 co2 172 7/18 7/30 72383 kidde 123 173 co2 173 7/18 7/30 49484 kidde 100 150 co2 150 7/18 7/30 24369 kidde 115 165 co2 165 7/18 7/30 84103 kidde 119 169 co2 169 7/18 7/30 61026 kidde 98 148 co2 148 7/18 7/30

System was tested with a 35LB CO2 cylinder

Andrew Johnson 4/4/2023

Location:

Qty of Cylinders: Cylinder Capacity:

Qty of Pilot Cylinders: Cylinder Capacity:

Carried Out Satisfactory

7. Checked operation of pressure switch(es)? Quantity: Yes No Yes No N/A

11. Checked other shutdowns? Specify: Yes No Yes No N/A

Set Time: Actual Time:

Electric Pneumatic

Room Temperature:

CYLINDERS (additional cylinders to be listed on following supplement, if applicable):

Serial # Manufacturer

Empty

Required

Agent

Actual

Temperature

°C/°F PSI/BAR Last Hydro

Date Next

Hydro Due

Technician: Date:

Manufacturer:

Space Protected:

19. Checked labeling of system components?

20. Is system sealed and inspection tag attached?

21. Is system armed and ready for use?

9. Checked damper operation?

13. Checked operation of alarms?

15. Checked operation of visual indication?

16. Checked operation of stop valves?

14. Type of Alarms

10. Checked fuel oil pump shutdown?

12. Time Delay

COMMENTS: ANY REMARKS plus EXPLAIN ANY NO Answers

I state that the information on this form is correct at the time and place of the inspection, and that all equipment tested at this time was left in operational condition upon completion of this inspection except as noted in Comments section above.

17. Checked operation of remote stations?

18. Checked operation of heat actuation?

3. Condition of cylinders (Satisfactory/Unsatisfactory)?

4. Checked for manufacturer recalls?

5. Checked lever/pressure actuation?

6. Checked condition of flex hoses?

8. Checked ventalation shutdown?

GENERAL REQUIREMENTS

1. Disconnect releasing mechanisms?

2. Contents in cylinders checked by weight/ liquid level?

Information on this form covers the minimum requirements of the current edition of 46CFR, appropriate classification requirements, as well as the latest version of the OEM manual (unless otherwise directed by the authority having jurisdiction).

SYSTEM INFORMATION

INSPECTION OF FIXED SUPPRESSION SYSTEM

Dates of Service

Comments

MFSS.46CFR.XX.01.001

US Army Corps of Engineers Kidde CO2 Room Pump room

4 50 2 50

N/A ✔ ✔ 30 30

0 ✔ ✔ 2 ✔ ✔

84116 kidde 98 148 50 148 7/18 7/30 26060 kidde 118 168 50 168 7/18 7/30 3064293 kidde 114 164 50 164 7/18 7/30 69310 kidde 100 150 50 150 7/18 7/30

System was tested with a 35LB CO2 cylinder.

Andrew Johnson 4/4/2023

LOCATION AGENT SIZE MFG

MFG

DATE

UL

RATING

GROSS

WGT

BRACKET

TYPE

LAST

HYDRO

HYDRO

DUE

LAST

6YR

6 YR

DUE

PASS FAIL

Date:

I state that the information on this form is correct at the time and place of the inspection, and that all equipment tested at this time was left in operational condition upon completion of this inspection except as noted in Comments section above.

Technician:

R=Recharge 6=Six Year Maint. H=Hydrotest A=Annual Re-Certification C=Condemned

Dates of Service:

INSPECTION OF PORTABLE EXTINGUISHERS

Information on this form covers the minimum requirements of the current edition of NFPA10, 46CFR, as well as the latest version of the OEM manual (unless otherwise directed by the authority having jurisdiction).

COMMENT KEY

SERIAL COMMENTS

MEXT.10.2018.01.001

US Army Corps Of Engineers

491449 Bridge CO2 15 35 Veh 4/23 4/28 ✔

7768931 Bridge ABC 10 2022 Veh 2028 ✔

19006543 Galley ABC 10 2024 Veh 2030 ✔

108190 Galley CO2 15 35 Veh 3/24 3/29 ✔

19006531 Passage Way ABC 10 2024 Veh 2030 ✔

181077 Passage Way CO2 15 35 Veh 4/24 4/29 ✔

794057 Engine Room Port CO2 15 4/23 4/28 ✔

527868 Engine Room STBD CO2 15 4/23 4/28 ✔

181078 Engine Room FWD CO2 15 4/24 4/29 ✔

801871 Engine Log Room ABC 20 1/24 1/30 ✔

528397 Tool Room ABC 20 2019 2025 ✔

3020400 Tool Room CO2 15 4/23 4/28 ✔

502237 Pump Room CO2 15 4/23 4/28 ✔

3020474 Cylinder Room CO2 15 4/23 4/28 ✔

2515379 Port Doghouse CO2 15 4/23 4/28 ✔

R/C Tool Room ABC 10 2022 2028 ✔

759765 Pump Room CO2 15 4/23 5/28 ✔

549906 Pump Room CO2 15 4/23 4/28 ✔

987374 Cylinder room CO2 15 4/23 4/28 ✔

Joe Sheridan 4/17/2023