STATE OF CALIFORNIA -GOVERNOR’S OFFICE OF EMERGENCY SERVICESFire and Rescue Branch

FIRE APPARATUS INVENTORY AND RECORD CONVERSION WORKSHEET- OES ENGINE’S 266 - 292

DATEOES ENGINE #

TYPE OF INVENTORY:(Check One)

ASSIGNED DEPARTMENT

CA EXEMPT LICENSE #

_ FIRE: FIRE NAME:

HOME REGION

HOME LOCATIONMILEAGE

HOME OPERATIONAL AREA

STRIKE TEAM #:ANNUAL

TRANSFER:

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED #/

ACTUAL #

Apparatus Cab1 Radio, Mobile 1 /

Serial #OES #DGS #

2 Radio, Handheld 1 /Serial #OES #DGS #

3 First Aid Kit (DOT) 1 /4 Intercom Headset 4 /56

Log Book, w / Credit Card 1 /Hand Lantern, 12-Volt 1 /

Compartment , Cross-Thru w/Slide Tool Tray7 Axe, Pick Head 1 /8 Axe, Flat Head 1 /9 Chain. 25’ Tow w / Grab Hooks 1 /10 Clamp, Hebert Hose 1 /11 Bar, Claw, Wrecking, 3' 2112 Bar, Pinch Point, 60" 4 /13 Cutter, Bolt, 30" 1 /14 Extinguisher, 5# A:B:C 1 /15 Hammer, 3 - 4 lb. Sledge, Short 2 /16 Hammer, 8 -10 lb. Sledge 2117 Hose. 6" x 12' Soft Suction 1 /18 Jack, 8-ton Hydraulic w / Handle 2119 McLeod 1 /20 Picket. Steel, 1" x 4’ 6 /21 Pulaski 1 /22 Triangle Reflector Set 1 /23 Shovel.Round Point, Long Handle 1 /24 Shovel, Square Point, Long Handle 1 /25 Strainer, 6" Suction 1 /26 Wrench, Hose Spanner <1 w to 21/2") 4 /27 Wrench, Adjustable Hydrant 21

Engineer’s Compartment

28 Adapter, 6" x 2 VS",DF, Hydrant 1 /29 Adapter, 6" x 4", DF, Hydrant 1 /30 Adapter, 6’x 4 Vi , DF, Hydrant 1 /

323334 Coupling, 2 Vi Double Female 2135 Coupling, 2 VS" Double Male 2136 Crank. Hose Reel 1 /37 Increaser, 1" NPSH F x 1 Vi NH M 1 /_38 Mallet, Rubber 1 /.39 Nozzle, 1" NPSH Combo Wildland40 Nozzle, 1Vi Combo Structural41 Nozzle, 1Vi NH Combo Wildland42 Nozzle, 1Vi Foam, Air Aspirating43 Nozzle, 2 Vi Shutoff w / Fog tip44 Nozzle, 2 Vi Shutoff w / 3 tips45 Reducer. 1 Vi NH F x 1" NPSH M46 Reducer, 2 Vi F x 1 Vi M47 Siamese, 2 Vi M x 2-2 Vi F48 Strap, Hose & Ladder49 Clamp. Wildland Hose50 Tee, Wildland Hose. 1YiNH x 1'NPSH

CORRECT PER ACTUAL COUNT

2 /21211 /1 /211 /1 /1 /4 /2 /3 /

SHORT#

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # /ACTUAL #

Engineer’s Compartment, coni51 Wrench, Wildland Spanner (1" to 1 Zf Forestry) 21.52 Wrench, Suction Hose Spanner 1 /53 Wye, 2 Vi NH F x 2-1Vi NH M 1 /54 San Francisco Hydrant Adapter (3" F x 2 jy M) 1 /

Driver’s Side, Compartment Above Rear Tires55 Caribiner, Locking uDn, 11 mm 12 /56 Edge Protection 2 /57 Emergency Signaling Device, Whistle 1 /58 Friction Device,Fig. 8 & Breaker Bar 1 ea/59 Harness, Body, Commercial60 Litter Pre-Rig

fi21.1 /

63 Prusik Loop / Gibbs Ascender 6 /64 Pulley, Rescue,TI 4* 3 /65 Rope, Kemmantle,Vi x 15C' 2166 Webbing Kit (See “Tool Info Sheet")

Driver's Side, Rear Compartment1 /

67 Can, Fuet (for generator) 1 /68 Generator 1 /

Serial #.OES #

Rear Compartment, Lower69 Belt, Carpenter 2170 Blade. Hacksaw. Package 3 /71 Chisel, Cold, 1’x 7 7/8" 21

73 Hacksaw 2174 Handsaw, Crosscut, 26" 2 /75 Hammer, 24 oz. Framing 3 /76 Hammer, 3 - 4 lb. Sledge, Short 21

79 Marking Kit, Building (See‘Tool info Sheep 1 /80 Nails @ 25 lb. ea, 16d, 8d, & 16d dpi 1 ea/

81 Shovel. Scoop w / “D" Handle 1 /82 Square, Tri or Speed83

3 /

84 Tape Measure, 25' 3 /

86 Tape, Duct 21

Rear Compartment, Upper88 Backboard 1 /.89 Ladder, 10' Attic 1 /90 Ladder, 14' Roof 1 /91 Ladder, 24' Extension92 Pike Pole. 8’93 Interface Hose Bars (perm, attached)

1 /1 /21

Passenger Side, Rear Compartment94 Can(s), Fuel (Chainsaw & Flotopump)

95 Chainsaw w/24" barSerial #OES #

21

1 /

SHORT#

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # / SHORTACTUAL #

Passenger Side, Rear Compartment, cont

#

96 Chainsaw Kit (see •Tool Info Sheet") | 1 /

98 Rope, 1/2" x 50’, Utility in bi 21>T«T

100101 Flotopump 1 /

Serial #OES #

102

103104Passenger Side, Compartment Above Rear Tires105106 Blanket, Disposable 21107 Litter Cover (if not in use) 1 /108 Trauma Kit 1 /

Passenger Side, Compartment Ahead of Rear Tires109 Thermo Gel Concentrate. 5 gallons 21110 Thermo Gel Backpack 1 /111 Thermo Gel Nozzle / Eductor / Hose 1 /112 Thermo Gel Pick-Up Tube 1 /113 Mount, Ground Deluge114

1 /

Hosebed and Reel Line Area115 Cribbing & Wedge Kit (See'Tool Info Sheen 1 /116 Hose,r NPSH x 100’ Wildland 4 /117 Hose, 1 Vi NH x 100’ Wildland 8 /118 Hose.1Vi NH x 50’ Structural 12 /119 Hose, 3" NH x 50’ Structural 24 /120 Hose, Booster. 1" NPSH x 100' 21121 Litter. Stokes Basket 1 /122 Deluge Monitor 1 /123 Stream Straightener124 Nozzles. Deluge (1 3/8’-1 VS’-1%’-

1 /

21 1 /125 Nozzle, Deluge, Combo 500-1250 GPM

Apparatus Exterior1 /

126 Cap, 2 Vi Discharge 5 /127 Chock Block 21128 Hose, Hard Suction, 6" x 10' 21129 Hose, 3" x 12' Soft Suction 21130 Plug, 2 Vi Suction 21

Front Bumper131 Hose, 1Vi x 35’ Truck Protection 1 /132 Nozzle, 1 Vi, Combo (Wildland) 1 /.NOTE: CELL SHADING indicates a DIFFERENCE in theitems assigned to this engine vs. those on OES E314- E359.It may be the number of items or the configuration of the items.Note any equipment damage below:

Recap AH OES-Owned Special Equipment Carried:

133 Manuals: Engine, Chassis, 1 ea./Transmission, and Pump

134 Straps, Pickoff 2 /135 Cord, Electrical (100’) 2 /136 Light, Halogen 110-volt 21

SIGNED:ASSIGNEE REPRESENTATIVE

TITLE: SIGNED: TITLE:OFFICE OF EMERGENCY SERVICES, FIRE & RESCUE BRANCH REPRESENTATIVE

DISTRIBUTION: Original: OES, Sacramento Yellow Copy: OES Field Assistant Chief Pink Copy: Assignee FORM F-157A (Revised 12/22/10)

DATE

ENGINE t 2-6^'TYPE OF INVENTORY:

(Check One)

STATE OF CALIFORNIA - EMERGENCY MANAGEMENT AGENCYFire and Rescue Branch

FIRE APPARATUS INVENTORY AND RECORD- ENGINE’S 314 - 359

HOME LOCATION

ANNUAL

TRANSFER:

ASSIGNED DEPARTMENT

CA EXEMPT LICENSE #

FIRE: FIRE NAME

HOME REGION

MILEAGE

STRIKE TEAM #:

HOME OPERATIONAL AREA

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED #I

ACTUAL #

Apparatus Cab1 Radio, Mobile 1 /

Serial #OES #DGS #

2 Radio. Handheld 1 /Serial #OES #DGS #

3 First Aid Kit (DOT) 1 /.4 Intercom Headset 4 /5 Log Book, w / Credit Card 1 /6 Hand Lantern, 12-Volt (Streamiiqht)

Compartment , Cross-Thru w/Slide Tool Tray789

Axe. Pick HeadAxe. Flat HeadChain, 25' Tow w / Grab Hooks

1 /1 /1 /

10 Clamp. Hebert Hose 1 /11 Bar , Claw, Wrecking, 3 2112 Bar, Pinch Point, 60' 4 /.13 Cutter, Bolt, 30" 1 /14 Extinguisher, 5# A:B:C 1 /15 Hammer. 3 - 4 lb. Sledge, Short 2 /16 Hammer , 8-101b. Sledge 2117 Hose, 6’ x 12’ Soft Suction 1 /18 Jack, 8-ton Hydraulic w / Handle 2 /19 McLeod ; Thao Glow 3/20 Picket, Steel 1" x 4 6 f

21 Pulaski 1 /22 Triangle Reflector Set 1 /23 Shovel, Round Point, Long Handle iL24 Shovel, Square Point. Long Handle 1 /25 Strainer, 6" Suction 1 /26 Wrench, Hose Spanner (1 to 21/2127 Wrench, Adjustable Hydrant

Engineer's CompartmentX

28 Adapter , 6” x 2 Vz" , DF, Hydrant 1 /29 Adapter, 6" x 4",DF, Hydrant 1 /30 Adapter. 6" x 4 Vz” , DF, Hydrant 1 /31 Aoopty -1" NPSH 4 » V-NH M (C99»w 432 /mop** r:NH L « 1" NPSH M (e55l»W 433 Aif Mesew;noaale 434 Coupling, 2 Vz" Double Female 2 /35 Coupling. 2 Vz" Double Male 2136 Crank, Hose Reel 1 /37 Increaser, 1’NPSH F x 11/2" NH M 1 /38 Mallet Rubber 1 /—39 Nozzle. T NPSH Combo Wildland A40 Nozzle. 1 Vz Combo Structural 21.41 Nozzle, 1 Vz NH Combo Wildland 2 /42 Nozzle, 1 Vz" Foam, Air Aspirating 1 /43 Nozzle, 2 Vz Shutoff w / Fog tip 1 /44 Nozzle, 2 7/ Shutoff w / 3 tips45 Reducer, 1y2" NH F x 1" NPSH M46 Reducer, 2 Vz F x 1 Vz M47 Siamese, 2 Vz” x 2-2 Vz48 Strap, Hose & Ladder49 Clamp, Wildland Hose50 Tee. Wildland Hose, 1Vz” NH x 1" NPSH

CORRECT PER ACTUAL COUNT

211 /

1 /4 /213 /

SHORTI ACTUAL *

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # I

Engineer’s Compartment cont.51 Wrencn, Wildland Spanner (V ic 1 V? Forestry) 2152 Wrench, Suction Hose Spanner 1 /53 Wye, 2 Vz" NH F x 2-1 W NH M 1 /54 San Francisco Hydrant Adapter (.r F x 2w M) 1 /

Driver’s Side, Compartment Above Rear Tires55 Caribiner, Locking *D". 11 mm56 Edge Protection 2 /57 Emergency Signaling Device Whistle 1 /58 Friction Devtce, Fig. 8 & Breaker Bar 1 ea;.59 Harness, Bocy +444 Cz> /»\ 2 /60 Litter Pre-Rig 1 /61 Load Roloaso62- Multi-point Collection Plate

•24-24

63 Prusik Loop/fg,AhiAsrtsv/c/"64 Pulley,Rescue.Pruak Minding2/r65 Rope, Kernmantle !4" x 150

S*'3/2 /

66 Webbing Kit (See “Tool Info Sheep 1 /Driver's Side, Rear Compartment

67 Can, Fuel (for generatof /portable pump) 1 /68 Generator 1 /

Serial #OES #

Rear Compartment. Lower69 Belt, Carpenter 34-..

70 Blade, Hacksaw CaMe 371 Chisel, Cold. rx 7 7/8" 2 /72 Chomtool Light Kit (Gee Teel lute Ghee*1 3473 Hacksaw 2174 Handsaw. Crosscut, 26" 2 /75 Hammer, 24 oz. Framing 3 /76 Hammer, 3 - 4 lb. Sledge. Short 2 /77 Kfttfo. Utility 478 Lowok4" Torpodc 4479 Marking Kit, Building (See -Tool info Sheer) 1 /.80 Nails @ 25 lb. ea, 16d & M, 1 ea/

81 Shovel, Scoop w / “D’Handle 1 /82 Square, Trior Speed 3783 Square. Eramwg- 34- 4484 Tape Measure. 25’ 3 /85 Tope. Borrior 4486 Tape, Duct 2187 Tool Kn i»o»"Tooi -mo Snoots 4

Rear Compartment, Upper88 Backboard 1 /89 Ladder, 10’ Attic 1 /90 Ladder. 14’ Roof 1 /91 Ladder, 24’ Extension 1 /92 Pike Pole. -S-eed 8 1 e»93 Interface Hose Bars (Up to E3 6 8 i 2 /Passenger Side, Rear Compartment94 Can(s), Fuel (Chainsaw * Flotopump) |

Note for #07 a #04? OES C330- E350 have o

~

total of two (3) fuel cane ano for straight-gsoolinofooftoblo pump & generator) andonefof 50:1mixed facl (chainsaw)?

95 Chainsaw w/24' bar 1 /Serial #OES #

SHORT#

ACCOUNTABLE: PROPERTY * EQUIPMENT ISSUED # 1ACTUAL * #

SHORT

Passenger Side, Rear Compartment, cont.96 Chainsaw Kit (see “Tool Info Sheet") 1 /97 2+98 Rope, 1/2* x 50’. Utility in bag 2199 Wronoh Adjuotoblo Hydrant-

or it

4n

101 Flotopump (E314 -E338) 1 /Senal #OES #_ .

102 Poftoble Pump (E330 E35fo 44Sonol ftPEG #

—103 Moca. * iv. 4104 StraiRO*!-Auction1114' £359) XXPassenger Side, Compartment Above Rear Tires105 P?f*hr»?rH 44106 Blanket. Disposable 27107 Litter Cover (if not in use) 1 /108 Trauma Kit 1 /

Passenger Side, Compartment Ahead of Rear Tires109 Thermo Gel Concentrate. 5 gallons 21110 Thermo Gel Backpack 1 /111 Thermo Gel Nozzle / Eouctor / Hose 1 /112 Thermo Gel Pick-Up Tube 1 /113 Mount Ground Deluge 1 /114 Salvage Cowre Gaavafr

Hosebed and Reel Line Area115 Cribbing & Wedge Kit (Seo'Tool Info Sheer*) 1 /y116 Hose. T NPSH x 100' Wildland

>g /117 Hose,1Vz NH x 100' Wildland118 Hose,1Vz NH x 50' Structural 12 /119 Hose, 3" NH x 50’ Structural 24 /120 Hose, Booster 1" NPSH x 100' 21121 Litter, Stokes Basket 1 /122 Deluge Monitor 1 /123 Stream Straightener 1 /124 Nozzles. Deluge (1 3/8M!4"-1 VA

1 /H125 Nozzle. Deluge. Combo 500-1250 GPM

Apparatus Exterior1 /

126 Cap, 21/»" Discharge SL127 Chock Block 21128 Hose, Hard Suction. 6* x 10 21129 Hose, 3" x 12’ Soft Suction 21130 Plug, 2 Vz" Suction

Front Bumper21

131 Hose, 1 Vz x 35' Truck Protection 1 /132 Nozzle, 1Vz" , Combo (Wildland)

NOTES:1 /

CELL SHADING INDICATES US&R INVENTORY"Tool Info Sheet” can be found in OES Yellow BinderNote any equipment damage below:

33 /77'" 'J* M/"/v ^1/.tlSj 7/wi

Recap All OES-OWne^ Special Equipment Carried:f 7'CT /T/3$ Ccu

M' ; J&VCXIXA/3*

SIGNED:ASSIGNEE REPRESENTATIVE

DISTRIBUTION: Onginal: EMA. Sacramentotgg* OSPOB 110428

TITLE:

Yellow Copy: Field Assistant Chief

SIGNED:FIRE & RESCUE BRANCH REPRESENTATIVE

Pink Copy: Assignee

TITLE:

FORM F-157A (Revised 1/6/09)