DATE

OES ENGINE #

TYPE OF INVENTORY:(Check One)

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

FIRE APPARATUS INVENTORY AND RECORD CONVERSION WORKSHEET- OES ENGINE’S 257 - 265

ASSIGNED DEPARTMENT HOME LOCATION

ANNUAL

DTRANSFER:

CA EXEMPT LICENSE #

f] FIRE: FIRE NAME:

HOME REGION

MILEAGE

STRIKE TEAM #:

HOME OPERATIONAL AREA

SHORTSHORTISSUED #/

ACTUAL ## #ACTUAL # #ACTUAL #

1 /

1 /

1 /3 /

SHORT ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # /

Passenger Side, Rear Compartment, cont.96 Chainsaw Kit (see‘Tool Info Sheet*)97

1 98 Rope, 1/2" x 50’, Utility in bag99100101 Flotopump

Serial #_1 /

OES #102

ACCOUNTABLE PROPERTY & EQUIPMENT

Apparatus Cab1 Radio, Mobile

Serial #OES #DGS #

2 Radio, HandheldSerial #OES #DGS #

3 First Aid Kit (DOT)4 Intercom Headset

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # /

Engineer’s Compartment, cont.51 Wrench, Wildland Spanner (1* lo1YT Forestry) 21.52 Wrench, Suction Hose Spanner 1 /53 Wye, 2 Vi NH F x 2-1 Vi NH M 1 /54 San Francisco Hydrant Adapter (3* F x 2 'A' M) 1 /

Driver’s Side, Compartment Above Rear Tires55 Caribiner, Locking UD", 11 rrm 12 /56 Edge Protection 21.

58 Friction Device, Fig. 8 & Breaker Bar 1 ea/59 Harness, Body, Commercial 21

I60 Litter Pre-Rig

63 Prusik Loop / Gibbs Ascender64 Pulley, Rescue, 2” / 4”65 Rope, Kernmantle, Vi x 150'

66 Webbing Kit (See “Tool Info Sheet")Driver’s Side, Rear Compartment

67 Can, Fuel (for generator)

68 GeneratorSerial #OES #.

Rear Compartment, Lower69 Belt, Carpenter70 Blade, Hacksaw, Package71 Chisel, Cold, 1" x 7 7/8"

73 Hacksaw74 Handsaw, Crosscut, 26"

75 Hammer, 24 oz. Framini

79 Marking Kit, Building (See‘Tod info Sheen80 Nails (5) 25 lb. ea, 16d, 8d, & 16d dpi

81 Shovel, Scoop w / *D" Handle82 Square, Trior Speed8384 Tape Measure, 25’

8586 Tape, Duct

Rear Compartment, Upper88 Backboard89 Ladder, 10' Attic90 Ladder, 14' Roof

5 Log Book, w / Credit Card 1 /6 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 2116 Hammer, 8 -10 lb. Sledge 2 /.17 Hose, 5" x 12' Soft Suction 1 /18 Jack, 8-ton Hydraulic w / Handle 2 /19 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. 5" Suction 1 /26 Wrench, Hose Spanner (1 /{ to 21/2") 4 /27 Wrench, Adjustable Hydrant 21

Engineer’s Compartment

28 Adapter, 5" x 2 Vi , DF, Hydrant 1 /29 Adapter, 5" x 4", DF, Hydrant 1 /30 Adapter, 5" x 4 Vi\ DF, Hydrant 1 /.

323334 Coupling, 2Vi Double Female 2 /35 Coupling, 214" Double Male 2 /

37 Increaser, 1" NPSH F x 1 Vi NH M 1 /38 Mallet , Rubber 1 /

103104

| Passenger 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 gallons110 Thermo Gel Backpack

2 /1 /

111 Thermo Gel Nozzle / Eductor / Hose 1 /112 Thermo Gel Pick-Up Tube 1 /113 Mount. Ground Deluge

Hosebed and Reel Line Area

1 /

115 Crit>tnng & Wedge Kit (See 'Tool Info Sheet*) 1 /116 Hose, 1" NPSH x 100' Wildland 4 /117 Hose, 1 Vi NH x 100' Wildland 8 /118 Hose, 1 Vz NH x 50' Structural 12 /119 Hose, 3" NH x 50’ Structural 24 /120 Hose, Booster, 1" NPSH x 150' 1 /121 Litter. Stokes Basket 1 /122 Deluge Monitor 1 /123 Stream Straightener 1 /124 Nozzles, Deluge (13/8*-1 %"-13//-

21 1 /125 Nozzle, Deluge, 350 - 500 GPM

Apparatus Exterior1 /

| 126 Cap, 2 Vi Discharge127 Chock Block

5 /21.

128 Hose, Hard Suction, 5" x 10’ 2 /.129 Hose, 2 1/2" x 12' Soft Suction 1 /130 Plug,2Vi Suction

Front Bumper2 /

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

1 /

6 /3 /2 /.1 /

1 /1 /

213 /2 /

212121

1 /1 ea/

1 /2 /

3 /.

21

1 /1 /1 /

I

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.

1 /1 /

91 Ladder, 24' Extension92 Pike Pole, 10'

212121

39 Nozzle, 1'NPSH Combo Wildland40 Nozzle, 1Vi Combo Structural41 Nozzle, 1Vi NH Combo Wildland42 Nozzle, 1Vi Foam, Air Aspirating 1 / Passenger Side, Rear Compartment Note any equipment damage below:43 Nozzle, 2Vi Shutoff w / Fog tip 1 / 94 Can(s), Fuel (Chainsaw & Flotopump) 2 /44 Nozzle, 2 Vi Shutoff w / 3 tips 21 Recap All OES-Owned Special Equipment Carried:45 Reducer, 1Vi NH F x 1" NPSH M 1 / 133 Lug wrench w/bars 1 /46 Reducer, 2Vi F x 1Vi M 1 / 134 Manuals: Engine, Chassis, 1 ea./.47 Siamese, 2 /4" M x 2-2Vi F 1 / Transmission, and Pump48 Strap, Hose & Ladder 4 / 95 Chainsaw w/24" bar 1 / 135 Straps, Pickoff 2149 Clamp, Wildland Hose 21 Serial # 136 Cord, Electrical 2150 Tee, Wildland Hose, 1K" NH xr NPSH

CORRECT PER ACTUAL COUNT

SIGNED:

3 /

TITLE:

O E S #

SIGNED:

137 Strainer, Foam 1 /

TITLE:ASSIGNEE REPRESENTATIVE

DISTRIBUTION: Original: OES, Sacramento Yellow Copy: OES Field Assistant Chief

OFFICE OF EMERGENCY SERVICES, FIRE & RESCUE BRANCH REPRESENTATIVE

Pink Copy: Assignee FORM F-157A (Revised 12/22/10)

DATE

ENGINEt

TYPE OF INVENTORY:- 1,

ANNUAL

STATE OF CALIFORNIA -EMERGENCY MANAGEMENT AGENCYFire and Rescue Branch

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

ASSIGNED DEPARTMENT.CA EXEMPT LICENSE #.

FIRE: FIRE NAME:

HOME LOCATION

MILEAGE

STRIKE TEAM #:

(Check One) TRANSFER: HOME REGION HOME OPERATIONAL AREA.SHORT ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # /

ACTUAL ##

Engineer's Compartment, corn.51 Wrench, Wddland Spanrw (1* lo 1 Ys’ Forestry) 2152 Wrench, Suction Hose Spanner 1 /53 Wye, 2 Yz NH F x 2-1 Yz NH M 1 /54 San Francisco Hydrant Adapter (3* F x 2 Yz Mj 1 /

Driver's Side, Compartment Above Rear Tires55 Caribiner, Locking “PL 11 mm ai56 Edge Protection 2157 ernerqeR6v^f»f>ekop Dovioo Whiotte58 Friction Device, Fig. 8 & Breaker Bar

441 eal

59 Harness, Body60 Litter Pre-Rig

211/

61 Loab-Retoege •2462 Multi point Gotieofron Plato £463 Prusik Loop / fisccd'?*64 PuIley,TteQBuo, Ptuoik Minding TV 'J 3 /65 Rope Kernmande, Yz x 150' 2 /66 Webbing Kit (See “Tool Info Sheet") 17

Driver's Side, Rear Compartment67 Can, Fuel (for generator/portable pump) 1 /68 Generator 1 /

Serial #.OES #

Rear Compartment, Lower69 Belt, Carpenter 2-70 Blade, Hacksaw, Gaffobo f71 Chisel, Cold, 1" x 7 7/8’ 2 /72 Chemical lwhH4k- < )ce^rei infe- Otieef73 Hacksaw 2774 Handsaw, Crosscut 26" 2 /75 Hammer, 24 oz. Framing 3 /

77 Kcute.76 Hammer:-3- - 4 lb. Slodgo

Utility., Short 34

U78 Level 6” Tetpedo 4479 Marking Kit, Building (See‘Tool into snee- 1/80 Nails @ 25 lb. ea, 16d & 8d

^: 1 ea/

81 Shovel, Scoop w / aD" Handle 1 /82 Square, Tri or Speed 2L83 Square:fremtng-, -241 4484 Tape Measure, 25 3 /85 Tape,- -Barber 4486 Tape, Duct87 T-oolKit (Soo “Tool Into Sheets

Rear Compartment, Upper

2 /-44

88 Backboard 1 /89 Ladder, 10’ Attic 1 /90 Ladder, 14’ Roof 1 /91 Ladder, 24' Extension 1 /92 Pike Pole, S-aa44 /Q' 1 MK93 Interface Hope Boro tHpto43a6r O )

Passenger Side, Rear Compartmentaa /

SHORT ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # /ACTUAL »

SHORT##

Passenger Side, Rear Compartment, cont.96 Chainsaw Kit (see "Tool Info Sheet") u97 Heat Bog 3498 Rope. 1/2" x 50’ , Utility in bag 2 /99 Wrench, Adjustable Hydrant- 44100 Wrench, Hose Seannner 24-101 Flotopump (E314 - E338)

Serial #OES #

102 Portable Pump (£389—E360)Serial #

1 /

4

OE6-#103 Heee - i-r » wT tM) 4104 Stfftnor . Station, 1>r (£339 £360) XPassenger Side, Compartment Above Rear Tires105 Backboato-Hooti immobiteofr 44106 Blanket Disposable 2 /107 Litter Cover (if not in use) 1 /108 Trauma Kit U

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 Deluge 1 /.114 SavageCovers , Cawae

Hosebed and Reel Line Area

O I

115 Chbfcing & Wedge Kit (Sec 'Tod Info Sheet*) 1 /116 Hose, 1nNPSHx 100’ Wildland

ai117 Hose, 114" NHx 100' Wildland —118 Hose, 1 Yz NH x 50’ Structural 12 /

24 /120 Hose, Booster , 1'NPSh t§0' 1121 Litter, Stokes Basket

119 Hose, 3T NH x 50' Structural,

1 /122 Deluge Monitor123 Stream Straightener124 Nozzles. Deluge (1 3/8‘-1 XA X -

1 /1 /

T ) 1 /125 Nozzle, Deluge,Corr 1 /

Apparatus Exterior126 Cap, 2 Yz Discharge 37127 Chock Block 21128 Hose, Hard129 HoseJfljjfc

Suetor..^' Soft Suctionx 10' 21.

±130 Plug, 2 V-i Suction^ 2 /

Front Bumper131 Hose,1 Yz x 35’ Truck Protection 1 /132 Nozzle, 1'A\Combo (Wildland) 1 /

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

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED #I

ACTUAL #

Apparatus Cab1 Radio, Mobile 1 /

Sena!#OES #DGS #

2 Radio. HandheldSerial #OES #

3DGS #First Aid Kit (DOT)

45

Intercom HeadsetLog Book, w / Credit Card

1 /

1 /

*1 /6 Hand Lantern, 12-Volt (Streamlight)

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 g x 12’ Soft Suction 1 /18 Jack, 8-tor Hydraulic w / Handle 2119 McLeod / Thou XL20 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 Handle25 StrainerSuction

11 /

26 Wrench, Hose Spanner (1 yy to 211T )27 Wrench, Adjustable Hydrant XL

Engineer's Compartment

28 AdapterJx 2 Yz" , DF, Hydrant 1 /29 Adapter , g" x 4", DF, Hydrant 1 /30 Adapter JT x 4 14", DF, Hydrant 1 /31 Aaaptef- -:-NPSHP* r NH M (633ft X32 Adaptorr MH r n r NPGi < M (E339 apt 433 Atf Hosew / fiezzie-34 Coupling, 2 14" Double Female

421

35 Coupling, 2 ’/2" Double Male 2136 OfanK. Hoae Red 4437 Increaser, 1" NPSH F x 1!4* NH M 1 /38 Mallet, Rubber 1 /39 Nozzle. 1’NPSH Combo Wildland 2J40 Nozzle, 1 Yz Combo Structural 2 /41 Nozzle, 1 y2" NH Combo Wildland 2142 Nozzle, 1 14" Foam, Air Aspirating 1 /43 Nozzle, 2 Yz Shutoff w / Fog tip44 Nozzle, 2 Yz Shutoff w / 3 tips45 Reducer, 1 y2" NH F xr NPSH M46 Reducer. 214" F x 1 Yz M47 Siamese, 2 Yz x 2-2 14"

V*

1 /.211 /1 /1 /

94 Can(s), Fuel (Chainsaw & Flotopump)

Note tor »04! OES £330 E350 hovcototal of two (2) tool cans - one tor straightgasobne(portable pump & generator) andooefor 60:1 mixod tool (chainsaw)

/33

C / ‘ ' -JS /j>

1or*fids iA>//ts*x

Recap All O^S-Owned Sdecial Equipment Carried:1 / /35 zn

j?/ rcu \̂r. f Z/.

SIGNED:FIRE & RESCUE BRANCH REPRESENTATIVE

Pink Copy: Assignee

TITLE:

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

48 Strap, Hose & Ladder 4 /49 Clamp, Wildland Hose 2150 Tee, Wildland Hose, 1W NH x 1" NPSH

CORRECT PER ACTUAL COUNT

SIGNED:ASSIGNEE REPRESENTATIVE

DISTRIBUTION: Onginal: EMA, SacramentoOSP OB 110428

95 Chainsaw w/24" barSerial #OES #

TITLE:

Yellow Copy: Field Assistant Chief