DO NOT REMOVE BY ORDER OF
TEXAS STATE FIRE MARSHAL
(until all conditions are corrected)
o System INOPERABLE o IMPAIRED or FAULT

Registered Firm’s Name
Street Address, City, State, Zip
Phone NumberACR-(number)

________________________________________________
Date        -        Licensee Signature        -        License #

List Conditions: __________________________________

________________________________________________

REPORT INOPERABLE TO OWNER & AHJ
(Orally immediately & in writing within next business day)
REPORT ALL OTHER TO OWNER & AHJ
(In writing within three business days)