STATE OF CALIFORNIA - GOVERNOR’S OFFICE OF EMERGENCY SERVICES Fire and Rescue Branch FIRE APPARATUS INVENTORY AND RECORD CONVERSION WORKSHEET- OES ENGINE’S 266 - 292 DATE ASSIGNED DEPARTMENT HOME LOCATION OES ENGINE # CA EXEMPT LICENSE # MILEAGE TYPE OF INVENTORY: ANNUAL _ FIRE: FIRE NAME: STRIKE TEAM #: (Check One) TRANSFER: HOME REGION HOME OPERATIONAL AREA

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # SHORT ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # / SHORT ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # / SHORT / # ACTUAL # # ACTUAL # # ACTUAL # Apparatus Cab Engineer’s Compartment, coni Passenger Side, Rear Compartment, cont • " 1 Radio, Mobile 1 / 51 Wrench, Wildland Spanner (1" to 1 Zf Forestry) 21. 96 Chainsaw Kit (see Tool Info Sheet ) | 1 / Serial # 52 Wrench, Suction Hose Spanner 1 / OES # 53 Wye, 2 Vi NH F x 2-1Vi NH M 1 / 98 Rope, 1/2" x 50’, Utility in bi 21 « DGS # 54 San Francisco Hydrant Adapter (3" F x 2 jy M) 1 / >T T 2 Radio, Handheld 1 / Driver’s Side, Compartment Above Rear Tires 100 Serial # 55 Caribiner, Locking uDn, 11 mm 12 / 101 Flotopump 1 / OES # 56 Edge Protection 2 / Serial # DGS # 57 Emergency Signaling Device, Whistle 1 / OES # 3 First Aid Kit (DOT) 1 / 58 Friction Device, Fig. 8 & Breaker Bar 1 ea/ 102 4 Intercom Headset 4 / 59 Harness, Body, Commercial 2 1. 5 Log Book, w / Credit Card 1 / 60 Litter Pre-Rig 1 / 6 Hand Lantern, 12-Volt 1 / 103 Compartment , Cross-Thru w/Slide Tool Tray fi 104 7 Axe, Pick Head 1 / 63 Prusik Loop / Gibbs Ascender 6 / Passenger Side, Compartment Above Rear Tires 8 Axe, Flat Head 1 / 64 Pulley, Rescue,TI 4* 3 / 105 9 Chain. 25’ Tow w / Grab Hooks 1/ 65 Rope, Kemmantle,Vi x 15C' 21 106 Blanket, Disposable 21 10 Clamp, Hebert Hose 1 / 66 Webbing Kit (See “Tool Info Sheet") 1 / 107 Litter Cover (if not in use) 1 / 11 Bar, Claw, Wrecking, 3' 21 Driver's Side, Rear Compartment 108 Trauma Kit 1 / 12 Bar, Pinch Point, 60" 4 / 67 Can, Fuet (for generator) 1 / Passenger Side, Compartment Ahead of Rear Tires 13 Cutter, Bolt, 30" 1 / 68 Generator 1 / 109 Thermo Gel Concentrate. 5 gallons 21 14 Extinguisher, 5# A:B:C 1 / Serial #. 110 Thermo Gel Backpack 1 / 15 Hammer, 3 - 4 lb. Sledge, Short 2 / OES # 111 Thermo Gel Nozzle / Eductor / Hose 1 / 16 Hammer, 8 -10 lb. Sledge 21 Rear Compartment, Lower 112 Thermo Gel Pick-Up Tube 1/ 17 Hose. 6" x 12' Soft Suction 1 / 69 Belt, Carpenter 21 113 Mount, Ground Deluge 1 / 18 Jack, 8-ton Hydraulic w / Handle 21 70 Blade. Hacksaw. Package 3 / 114 19 McLeod 1 / 71 Chisel, Cold, 1’x 7 7/8" 21 Hosebed and Reel Line Area 20 Picket. Steel, 1" x 4’ 6 / 115 Cribbing & Wedge Kit (See 'Tool Info Sheen 1 / 21 Pulaski 1 / 73 Hacksaw 21 116 Hose, r NPSH x 100’ Wildland 4 / 22 Triangle Reflector Set 1 / 74 Handsaw, Crosscut, 26" 2 / 117 Hose, 1 Vi NH x 100’ Wildland 8 / 23 Shovel. Round Point, Long Handle 1 / 75 Hammer, 24 oz. Framing 3 / 118 Hose. 1Vi NH x 50’ Structural 12 / 24 Shovel, Square Point, Long Handle 1 / 76 Hammer, 3 - 4 lb. Sledge, Short 21 119 Hose, 3" NH x 50’ Structural 24 / ' 25 Strainer, 6" Suction 1 / 120 Hose, Booster. 1" NPSH x 100 21 / 26 Wrench, Hose Spanner <1 w to 21/2") 4 / 121 Litter. Stokes Basket 1 27 Wrench, Adjustable Hydrant 21 79 Marking Kit, Building (See‘Tool info Sheep 1 / 122 Deluge Monitor 1 / Engineer’s Compartment 80 Nails @ 25 lb. ea, 16d, 8d, & 16d dpi 1 ea/ 123 Stream Straightener 1 / 124 Nozzles. Deluge (1 3/8’-1 VS’-1%’- 28 Adapter, 6" x 2 VS",DF, Hydrant 1 / 81 Shovel. Scoop w / “D" Handle 1 / 21 1 / 29 Adapter, 6" x 4", DF, Hydrant 1 / 82 Square, Tri or Speed 3 / 125 Nozzle, Deluge, Combo 500-1250 GPM 1 / 30 Adapter, 6’x 4 Vi , DF, Hydrant 1 / 83 Apparatus Exterior 84 Tape Measure, 25' 3 / 126 Cap, 2 Vi Discharge 5 / 32 127 Chock Block 21 33 86 Tape, Duct 21 128 Hose, Hard Suction, 6" x 10' 21 34 Coupling, 2 Vi Double Female 21 129 Hose, 3" x 12' Soft Suction 21 35 Coupling, 2 VS" Double Male 21 Rear Compartment, Upper 130 Plug, 2 Vi Suction 21 36 Crank. Hose Reel 1 / 88 Backboard 1 /. Front Bumper 37 Increaser, 1" NPSH F x 1 Vi NH M 1/_ 89 Ladder, 10' Attic 1 / 131 Hose, 1Vi x 35’ Truck Protection 1 / 38 Mallet, Rubber 1 /. 90 Ladder, 14' Roof 1 / 132 Nozzle, 1 Vi , Combo (Wildland) 1 /. 39 Nozzle, 1" NPSH Combo Wildland 2 / 91 Ladder, 24' Extension 1 / NOTE: CELL SHADING indicates a DIFFERENCE in the 40 Nozzle, 1Vi Combo Structural 21 92 Pike Pole. 8’ 1 / items assigned to this engine vs. those on OES E314- E359. configuration of the items. 41 Nozzle, 1Vi NH Combo Wildland 21 93 Interface Hose Bars (perm, attached) 21 It may be the number of items or the damage 42 Nozzle, 1Vi Foam, Air Aspirating 1 / Passenger Side, Rear Compartment Note any equipment below: 43 Nozzle, 2 Vi Shutoff w / Fog tip 1 / 94 Can(s), Fuel (Chainsaw & Flotopump) 21 44 Nozzle, 2 Vi Shutoff w / 3 tips 21 Recap AH OES-Owned Special Equipment Carried: 45 Reducer. 1 Vi NH F x 1" NPSH M 1 / 46 Reducer, 2 Vi F x 1 Vi M 1 / 133 Manuals: Engine, Chassis, 1 ea./ 47 Siamese, 2 Vi M x 2-2 Vi F 1 / Transmission, and Pump / 48 Strap, Hose & Ladder 4 / 95 Chainsaw w/24" bar 1 / 134 Straps, Pickoff 2 49 Clamp. Wildland Hose 2 / Serial # 135 Cord, Electrical (100’) 2 / 136 Light, Halogen 110 volt 21 50 Tee, Wildland Hose. 1Yi NH x 1' NPSH 3 / OES # -

CORRECT PER ACTUAL COUNT

SIGNED: TITLE: SIGNED: TITLE: ASSIGNEE REPRESENTATIVE 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 STATE OF CALIFORNIA - EMERGENCY MANAGEMENT AGENCY Fire and Rescue Branch FIRE APPARATUS INVENTORY AND RECORD- ENGINE’S 314 - 359 DATE ASSIGNED DEPARTMENT HOME LOCATION ENGINE t 2-6 ' CA EXEMPT LICENSE # MILEAGE TYPE OF INVENTORY^: ANNUAL FIRE: FIRE NAME STRIKE TEAM #: (Check One) TRANSFER: HOME REGION HOME OPERATIONAL AREA

ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # SHORT ACCOUNTABLE PROPERTY & EQUIPMENT ISSUED # I SHORT ACCOUNTABLE: PROPERTY EQUIPMENT ISSUED # 1 SHORT I I ACTUAL # * ACTUAL # ACTUAL # * * Apparatus Cab Engineer’s Compartment cont. Passenger Side, Rear Compartment, cont. ( ") 1 / 1 Radio, Mobile 1 / 51 Wrencn, Wildland Spanner (V ic 1 V? Forestry) 21 96 Chainsaw Kit see “Tool Info Sheet Serial # 52 Wrench, Suction Hose Spanner 1 / 97 2+ OES # 53 Wye, 2 Vz" NH F x 2-1 W NH M 1 / 98 Rope, 1/2* x 50’. Utility in bag 21 DGS # 54 San Francisco Hydrant Adapter (.r F x 2w M) 1 / 99 Wronoh Adjuotoblo Hydrant - 4 n 2 Radio. Handheld 1 / Driver’s Side, Compartment Above Rear Tires or it Serial # 55 Caribiner, Locking *D". 11 mm 101 Flotopump (E314 - E338) 1 / OES # 56 Edge Protection 2 / Senal # DGS # 57 Emergency Signaling Device Whistle 1 / OES #_ . ; ( 3 First Aid Kit (DOT) 1 /. 58 Friction Devtce, Fig. 8 & Breaker Bar 1 ea. 102 Poftoble Pump E330 E35fo 44 4 Intercom Headset 4 / 59 Harness, Bocy +444 Cz> /»\ 2 / Sonol ft — 5 Log Book, w / Credit Card 1 / 60 Litter Pre-Rig 1 / PEG # 6 Hand Lantern, 12-Volt (Streamiiqht) 61 Load Roloaso •24 103 Moca. * iv. 4 ' Compartment , Cross-Thru w/Slide Tool Tray 62- Multi-point Collection Plate -24 104 StraiRO*!- Auction1114 £359) XX 7 Axe. Pick Head 1 / 63 Prusik Loop/fg,AhiAsrtsv/c/" S Passenger Side, Compartment Above Rear Tires 8 Axe. Flat Head 1/ 64 Pulley,Rescue.Pruak Minding2/r '3*/ 105 P?f*hr»?rH 44 9 Chain, 25' Tow w / Grab Hooks 1 / 65 Rope, Kernmantle !4" x 150 2 / 106 Blanket. Disposable 27 10 Clamp. Hebert Hose 1 / 66 Webbing Kit (See “Tool Info Sheep 1 / 107 Litter Cover (if not in use) 1 / 11 Bar , Claw, Wrecking, 3 21 Driver's Side, Rear Compartment 108 Trauma Kit 1 / , Compartment Ahead of Rear Tires 12 Bar, Pinch Point, 60' 4 /. 67 Can, Fuel (for generatof/portable pump) 1 / Passenger Side 13 Cutter, Bolt, 30" 1 / 68 Generator 1 / 109 Thermo Gel Concentrate. 5 gallons 21 14 Extinguisher, 5# A:B:C 1 / Serial # 110 Thermo Gel Backpack 1 / 15 Hammer. 3 - 4 lb. Sledge, Short 2 / OES # 111 Thermo Gel Nozzle / Eouctor / Hose 1 / 16 Hammer , 8 -101b. Sledge 21 Rear Compartment. Lower 112 Thermo Gel Pick-Up Tube 1/ ’ Ground Deluge 1 / 17 Hose, 6’ x 12 Soft Suction 1 / 69 Belt, Carpenter 34-.. 113 Mount 18 Jack, 8-ton Hydraulic w / Handle 2/ 70 Blade, Hacksaw CaMe 3 114 Salvage Cowre Gaavafr 19 McLeod ; Thao Glow 3/ 71 Chisel, Cold. rx 7 7/8" 2 / Hosebed and Reel Line Area 20 Picket, Steel 1" x 4 6 f 72 Chomtool Light Kit (Gee Teel lute Ghee*1 34 115 Cribbing & Wedge Kit (Seo 'Tool Info Sheer*) 1 / 21 Pulaski 1 / 73 Hacksaw 21 116 Hose. T NPSH x 100' Wildland y 22 Triangle Reflector Set 1 / 74 Handsaw. Crosscut, 26" 2 / 117 Hose,1 Vz NH x 100' Wildland >g / ,1 NH x 50' Structural 12 / 23 Shovel, Round Point, Long Handle iL 75 Hammer, 24 oz. Framing 3 / 118 Hose Vz 24 Shovel, Square Point. Long Handle 1/ 76 Hammer, 3 - 4 lb. Sledge. Short 2 / 119 Hose, 3" NH x 50’ Structural 24 / " ' 25 Strainer, 6" Suction 1 / 77 Kfttfo. Utility 4 120 Hose, Booster 1 NPSH x 100 21 " Torpodc , Basket 1 / 26 Wrench, Hose Spanner (1 to 21/21 78 Lowok4 44 121 Litter Stokes 27 Wrench, Adjustable Hydrant X 79 Marking Kit, Building (See -Tool info Sheer) 1/. 122 Deluge Monitor 1 / Engineer's Compartment 80 Nails @ 25 lb. ea, 16d & M, 1 ea/ 123 Stream Straightener 1 / 124 Nozzles. Deluge (1 3/8M!4"-1 VA 1 / 28 Adapter , 6” x 2 Vz" , DF, Hydrant 1 / 81 Shovel, Scoop w / “D’Handle 1/ H 29 Adapter, 6" x 4", DF, Hydrant 1 / 82 Square, Trior Speed 37 125 Nozzle. Deluge. Combo 500-1250 GPM 1 / Hydrant Square . Eramwg 34 44 Apparatus Exterior 30 Adapter. 6" x 4 Vz” , DF, 1 / 83 - - 31 Aoopty -1" NPSH 4 » V-NH M (C99»w 4 84 Tape Measure. 25’ 3 / 126 Cap, 21/»" Discharge SL 32 /mop r:NH L « 1" NPSH M (e55l» W 4 85 Tope. Borrior 44 127 Chock Block 21 ** * 33 Aif Mesew;noaale 4 86 Tape, Duct 21 128 Hose, Hard Suction. 6 x 10 21 34 Coupling, 2 Vz" Double Female 2 / 87 Tool Kn i»o»"Tooi - mo Snoots 4 129 Hose, 3" x 12’ Soft Suction 21 35 Coupling. 2 Vz" Double Male 21 Rear Compartment, Upper 130 Plug, 2 Vz" Suction 21 36 Crank, Hose Reel 1 / 88 Backboard 1 / Front Bumper , ' Protection 1 / 37 Increaser, 1’ NPSH F x 11/2" NH M 1 / 89 Ladder, 10’ Attic 1 / 131 Hose 1 Vz x 35 Truck 38 Mallet Rubber 1 /— 90 Ladder. 14’ Roof 1 / 132 Nozzle, 1Vz" , Combo (Wildland) 1 / 39 Nozzle. T NPSH Combo Wildland A 91 Ladder, 24’ Extension 1 / NOTES: 40 Nozzle. 1 Vz Combo Structural 21. 92 Pike Pole. -S-eed 8 1 e» CELL SHADING INDICATES US&R INVENTORY 41 Nozzle, 1 Vz NH Combo Wildland 2 / 93 Interface Hose Bars (Up to E3 6 8 i 2 / "Tool Info Sheet” can be found in OES Yellow Binder , " , Passenger Side, Rear Compartment Note any equipment damage below: 42 Nozzle 1 Vz Foam Air Aspirating 1 / ~ 43 Nozzle, 2 Vz Shutoff w / Fog tip 1 / 94 Can(s), Fuel (Chainsaw Flotopump) | # #04? * C330 E350 have o 'J /"/v 44 Nozzle, 2 7/ Shutoff w / 3 tips 21 Note for 07 a OES - 33 /77'" * M 1/ . y" (3) cane ano for straight /wi 45 Reducer, 1 2 NH F x 1" NPSH M 1/ total of two fuel - tlSj 7 ^ ^ 46 Reducer, 2 Vz F x 1 Vz M gsoolinofooftoblo pump & generator) and 47 Siamese, 2 Vz” x 2-2 Vz 1 / onefof 50:1 mixedfacl (chainsaw)? Recap All OES-OWne Special Equipment Carried: ' ^ 48 Strap, Hose & Ladder 4 / 95 Chainsaw w/24 bar 1/ /3$ Ccu f7'CT /T 49 Clamp, Wildland Hose 21 Serial # /3 'M; J^&VCXIXA 50 Tee . Wildland Hose, 1 Vz” NH x 1" NPSH 3 / OES # *

CORRECT PER ACTUAL COUNT

SIGNED: TITLE: SIGNED: TITLE: ASSIGNEE REPRESENTATIVE FIRE & RESCUE BRANCH REPRESENTATIVE DISTRIBUTION: Onginal: EMA. Sacramento Yellow Copy: Field Assistant Chief Pink Copy: Assignee FORM F-157A (Revised 1/6/09) tgg* OSPOB 110428