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 253 - 256

y ANNUAL

TRANSFER:

ASSIGNED DEPARTMENT^CA EXEMPT LICENSE #

[JFIRE: FIRE NAME:HOME REGION

HOME LOCATION

MILEAGE

STRIKE TEAM #:

HOME OPERATIONAL AREA

SHORT#

ISSUED # /ACTUAL #

ISSUED # /ACTUAL #

2 /.

SHORT#

SHORTn

ISSUED #/

ACTUAL #

1 /

ACCOUNTABLE PROPERTY & EQUIPMENT

Passenger Side, Rear Compartment, cont96 Chainsaw Kit (see “Tool Info Sheet")

ACCOUNTABLE PROPERTY & EQUIPMENT

Engineer's Compartment, cont.51 Wrench, Wildland Spanner (1* to 1'A' Forestry)

Rope, 1/2” x 50’, Utility in bag

ACCOUNTABLE PROPERTY & EQUIPMENT

Apparatus Cab1 Radio, Mobile

Serial #OES #DGS #

2 Radio, HandheldSerial #OES #DGS #

3 First Aid Kit (DOT)4 Intercom Headset

MI100101 Flotopump

Serial #OES #

102

52 Wrench, Suction Hose Spanner 1 /53 Wye, 214" NH F x 2-1 Vf NH M 1 /54 San Francisco Hydrant Adapler (3~ F x 2 W M) 1 /

Driver's Side, Compartment Above Rear Tires55 Caribiner, Locking "D", 11 mm 12 /56 Edge Protection 2 /

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

1 /1 /

1 /4 /

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, 60'13 Cutter, Bolt, 30"14 Extinguisher. 5# A:B:C

4 /1 /1/

15 Hammer, 3 - 4 lb. Sledge, Short 2116 Hammer, 8 - 10 lb. Sledge 2117 Hose, 5" x 12’ Soft Suction 1 /18 Jack, 8-ton Hydraulic w / Handle 2119 McLeod20 Picket, Steel, 1" x 4

1 /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 (iw to 21/2*) 4 /27 Wrench, Adjustable Hydrant 21

Engineer’s Compartment28 Adapter, 5" x 2 DF, Hydrant 1 /29 Adapter, 5” x 4", DF, Hydrant 1 /30 Adapter, 5" x 4 V/, DF,Hydrant 1 /.

34 Coupling, 2Vi Double Female35 Coupling, 2 Vz Double Male

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

I60 Litter Pre-Rig 1 /

63 Prusik Loop / Gibbs Ascender 6 /64 Pulley, Rescue, 2" / 4" 3 /65 Rope, Kernmantle,W x 150’ 2166 Webbing Kit (See “Tool Info Sheet")

Driver's Side, Rear Compartment1 /.

67 Can. Fuel (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. Framini 2 /

79 Marking Kit, Building (See‘Tool info Sheet’) | 1 /80 Nails @ 25 lb. ea, 16d, 8d, & 16d dpi81 Shovel, Scoop w / UD" Handle82 Square, TriorS|

84 Tape Measure, 25’

8586 Tape, Duct

Rear Compartment, Upper88 Backboard89 Ladder, 10’ Attic90 Ladder, 14’ Roof91 Ladder, 24’ Extension92 Pike Pole, 10’

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

103104Passenger Side, Compartment Above Rear Tires105106 Blanket, Disposable 21.107 Litter Cover (if not in use) 1 /108 Trauma Kit 1 /

Passenger Side, Compartment Ahead of Rear Tires109 Thermo Gel Concentrate, 5 gallons 2 /110 Thermo Gel Backpack 1 /.111 Thermo Gel Nozzle / Eductor / Hose 1 /112 Thermo Gel Pick-Up Tube 1 /113 Mount, Ground Deluge 1 /.

Hosebed and Reel Line Area115 Crbbing & Wedge Kit (See ‘Tool info Sheep n116 Hose, 1" NPSHx 50’ Wildland 8 /117 Hose, 1 %" NHx 100’ Wildland 8 /118 Hose, 1V{ NH x 50' Structural 12 /119 Hose. 2 1/2" 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 (13f-1y/-2") 1 /125 Nozzle, Deluge, 350 - 500 GPM

Apparatus Exterior1 /

126 Cap, 2 V/ Discharge 5 /.127 Chock Block128 Hose, Hard Suction, 5" x 10’129 Hose. 2 1/2" x 12’ Soft Suction

21.21.1 /

130 Plug, 21/a" SuctionFront Bumper

2 /

131 Hose, 1 x 35’ Truck Protection 1L132 Nozzle, 1 K", 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:

2121211 /

39 Nozzle, 1" NPSH Combo Wildland40 Nozzle, 1Vi Combo Structural41 Nozzle, 1Vi NH Combo Wildland42 Nozzle, 1Vi Foam, Air Aspirating

1 /.21

43 Nozzle, 2 Vi Shutoff w / Fog tip44 Nozzle, 2 Vi Shutoff w / 3 tips45 Reducer, 1 NH F x 1* NPSH M 1 / Recap All OES-Owned Special Equipment Carried:46 Reducer. 2W F x 1Vi M 1 / 133 Lug wrench w/bars 1 /47 Siamese, 2 Vi M x 2-2%9 F 1 / 134 Manuals: Engine, Chassis 1 ea./48 Strap, Hose & Ladder 4 / 95 Chainsaw w/24" bar 1 /. Transmission, and Pump49 Clamp, Wildland Hose 21 Serial # 135 Straps, Pickoff 2150 Tee, Wildland Hose, 1 Vi NH x 1“ NPSH

CORRECT PER ACTUAL COUNT

3 /

SIGNED:ASSIGNEE REPRESENTATIVE

DISTRIBUTION: Original: OES. Sacramento

TITLE:

OES # 136 Cord, Electrical 2 1.

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

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

STATE OF CALIFORNIA - EMERGENCY MANAGEMENT AGENCYFire and Rescue Branch

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

DATEENGINE # - 2TYPE OF INVENTORY:

(Check One)

ASSIGNED DEPARTMENT.CA EXEMPT LICENSE #

ANNUALTRANSFER:

FIRE: FIRE NAME:

HOME REGION

HOME LOCATIONMILEAGE

HOME OPERATIONAL AREA

STRIKE TEAM #:

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED */ACTUAL r

Apparatus Cab1 Radio, Mobile 1 /

Serial #OES #DGS #

2 Radio, Handheld 1 /Sena! #OES #DGS #

3 First Aid Kit (DOT) 1 /4 Intercom Headset 4 /5 Log Book, w / Credit Card 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' 2 /.12 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 21.17 HoseS x 12' Soft Suction18 Jack , 8-ton Hydraulic w / Handle

1 /21

/19 McLeod / Thac Claw *20 Picket, Steel 1" x 4' 6 /21 Pulaski22 Triangle Reflector Set

1 /1 /

23 Shovel, Round Point, Long Handle24 Shovel, Square Point, Long Handle

1 /1 /

25 Strainer,Jf Suction

E1 /

26 Wrencn Hose Spanner (1 w to 21/D27 Wrench, Adjustable Hydrant

Engineer's Compartment

28 Adapte' £ x 2 Vz” , DF, Hydrant 1 /29 Adapter J" x 4”, DF, Hydrant 1 /30 Adapter X * 4 Vz , DF, Hydrant 1 /

32 Ani.Mtir. ttNMSii r fcIPSM M31 Aflepwf 1“ NP6*IF w 1" Ml » 4

33 -ArrHoGo wr noaalQ34 Coupling, 2 Vz" Double Female

4421

35 Coupling, 2 Vz Double Male 2 136 Crank, I looo Rooi 4437 Increaser, 1" NPSH F x 1 Vz NH M 1 /38 Mallet, Rubber 1 /39 Nozzle. 1’NPSH Combo Wildland40 Nozzle, 1 Vz Combo Structural41 Nozzle, 1 Vz NH Combo Wildland42 Nozzle, 1Vz Foam, Air Aspirating43 Nozzle, 2 Vz Shutoff w / Fog tip

44 Nozzle,2 14" Shutoff w / 3 bps45 Reducer, 1Vz N H F x 1’NPSH M46 Reducer, 2 %" F x 1 Vt M47 Siamese. 2 1/2" x 2-21/2"48 Strap, Hose & Ladder49 Clamp, Wildland Hose53 Tee, Wildland Hose, 1V NH x 1* NPSH

CORRECT PER ACTUAL COUNT

4 /2121.1 /1 /2 /1 /1 /1 /4 /213 /

SHORT#

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED * /ACTUAL *

Engineer's Compartment, cont.51 Wreocfi, Wildland Spannor (1* to 1 16* Forestry) 2152 Wrench, Suction Hose Spanner 1 /53 Wye, 2 Vz NH F x 2-1 Vz NH M54 San Francisco Hydrant Adapter (3* Fx 2W M)

1 /1 /

Driver's Side, Compartment Above Rear Tires55 Caribiner, Locking “D*. 11 mrr BJ.

56 Edge Protection 2 /57 - 4458 Friction Device. Fig. 8& Breaker Bar 1ea'59 Harness, Body NFf¥r 2 /60 Litter Pre-Rig 1 /.61 Load ROIQQOO62 Multi-point Cetocton Plate63 Prusik Loop r /Cft

£ / ""44rW

64 Pulley. Rescue. PfuoiftMtfHhng-2?V\^i65 Rope, Kemmantle,!4" x 150' * 2166 Webbing Kit (See Tool Info Sheer)

Driver's Side, Rear CompartmentU

67 Can, Fuei (for generator/pcnabie pump) 1 /68 Generator 1 /

Serial #OES #

Rear Compartment, Lower69 Belt, Carpenter70 Blade, Hacksaw, Gartwdo i71 Chisel, Cold, 1" x 7 7/8" 2 /72 GfrOffweet Light (Gee ^eol iwte Ghee* £473 Hacksaw74 Handsaw. Crosscut, 26"

2 /21

75 Hammer76 Hammer.. 24 oz. Framing

3 4 lb, Stodge, -Shart. Z.44

77 Knifa. Utility- 4478 LOMOI , 6" Toffiooe- 3479 Marking Kit. Building (See ‘Tool into sneer) 1 /80 Nails @ 25 lb. ea, 16d S 8c .U.,) 1ea/

81 Shovel, Scoop w / "D" Handle 1 /.82 Square, Tri or Speed X83 Square, Framing. 24- 44

85 4m-Jirrtor84 Tape Measure. 25’ 3 /

86 Tape. Duct»00 •

i 00".nw:, - 2 /4487 TQ4 Kit i

Rear Compartment, Upper88 Backboard 1 /89 Ladder. 10’ Attic 1 /90 Ladder, 14’ Roof 1 /91 Ladder, 24' Extension92 Pike Pole £-«44' /O'93 Interface Hose Bars iu»w S338)

1 /1«aI34

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

Netofor #67 & #04; OES £339 £860 hove &

( jiit.olino (portabie^wnp & (K>rwfaU)f » 'aB4totek two (0) fuei cons one for straight-ono for 80i1miwod fuel (ohoiftoowk

95 Chainsaw w/24” barSerial #

1 /

OES #

SHORT#

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUEDACTUAL* /

»SHORT

*Passenger Side, Rear Compartment, cont.

96 Chainsaw Kit (see Tool Info Sheet") M97 ^ i

98 Rope, 1/99 Wrench..2* x

Ad50’. Utility in bag

|UEtabte Hydrant21

100 Wranirh Hnse Spammer •: t« a* 4101 Flotopump (E314-E338) 1 /

Sena! #OES #

102 Portaolo flump (C330Sow* ft

44

QEC103 I lose >! ! IPTIWOUCUVTTTLUT'

104 Strainer, Section V* (3339 S334 4Passenger Side, Compartment Above Rear Tires105 Bacfcboard Hood ImrooMiaor 44106 Blanket. Disposable 21.107 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 Solvofp Govoro Gome*

1 /

Hosebed and Reel Line Area115 Cribbing & Wedge Kit (See 'Tool Info Sheet') 1 /116 Hose, r NPSH xJPWildland117 Hose. 1 Vz NH x 100' Wildland

8 /m

118 Hose, 1 Vz NH x 50’ Structural 12 /24 /.119 HoseZffi- * 50’ Structural

120 Hose Booster, 1" NPSP xl&O JL121 Litter, Stokes Basket 1 /.122 Deluge Monitor 1 /123 Stream Straightener 1 /124 Nozzles. Deluge (WT-1!4"-17) 1 /125 Nozzle, Deluge. C O M P Q > 1 /

Apparatus Exterior

127 Chock Block 2 /126 Cap, 2 Vz Discharge %

128 Hose, Hard S u c t i o n 1 0’ 21129 Hose, 12’ Soft Suction130 Plug, 2%*Suctior

121

Front Bumper131 Hose, 1 Vz x 35’ Truck Protection 1 /132 Nozzle, 1 Combo (Wildland) 1 /

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

/3/' A • JAP

Recap All CfES-OwnedSpecial Equipment Carried:

/J* c?

SIGNED:ASSIGNEE REPRESENTATIVE

DISTRIBUTION: Original: EMA, SacramentoOSP 08 110428

TITLE:

Yellow Copy: Field Assistant Chief

SIGNED:FIRE & RESCUE BRANCH REPRESENTATIVE

Pink Copy: Assignee

TITLE:

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