INITIAL El SUPPLEMENTAL fij Kings; [1 ADULT WATER PARK GHIO OF AGRICULTURE AMUSEMENT RIDE SAFETY DIVISION 8995 E. MAIN STREET REYNOLDSBURG, 01-E0 43968 Phone 614-323-6280 Fax 45' PI..ATE NO. EATE COMPANY LOCATIQN coon; (Ni) Satisfactory (U) Unsatisfactory (N) Not Applicable (R) Remarks U3 SITE . No visibie adjacent hazards andfor interferences .. PM MFG - SERIAL THEME NAME - . Fencing, railings and gates in place .. . Steps iadders recessed .. . Fire extinguishers in piace .. . No visible unguarded pinch points or hazardous projections .. STRUCTEJRAL 1 1. Visual appearance indicates proper 12. Visibly free of cracks or excessive wear .. 13. No missing bolts, or bolts of improper grade .. 14. Pins retainers in place .. 15. Chemicais stored~area free of obvious 16. Motors, clutches controls fimctioning when viewed .. 17. Brakes stops furictionai .. I8. Hydrauiic system shows no excessive wear .. 19. Air system functional .. 2. In level position where applicable .. 3. Secure hand holds .. 4. Blocked jacked .. 5. Motors, belts cables guarded .. '-in 6. Stairs walkways-- no obvious hazards .. 7 8 9 cs- ELECTRICAL SAFETY 20. Ride transformer generators guarded, ground rod connected .. 20. 21. Electrical boxes have covers, iatches signs .. 21. 22. Switches controls operations} .. 22. 23. No unattached, unconnected or unguarded fighting detected. . . . . 23. 24. Communication system operational .. 24. GFERATEON 25. Rest periods provided .. 25. 26- Number of guards as required .. 26. 27. Height requirements posted .. 27. 28. Proper warning signs (exit, entrance rules) .. 28. 29. Safety equipment in piace .. 29. 30. Signal system functions} .. 30. 31. Operator guard certifications .. 3 Z. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervals .. 34. 35. Proper Eoading, unloading operating procedures followed .. 35. MISCELLANEOUS SAFETY ITEMS 36. P.F.D.'s avaiiable at no charge .. 36. 37. Warning signs (exit, entrance rules) in piece .. 37. 38. Water test kit avaiiabie .. 38. 39. Chlorine residual within specification .. 39. 40. PH within specification .. 40. 41. Electrical supply source .- 41. Portable Generator Utility Power My signature cerzifies that I have read the Owner/Agent Notice on the reverse side and agree to fuiifp of! statutory requiremenas listed . ff. - . 1; OWNERJA . GNATURE INSPECTEWR SIGNA ORDERJREMARKS FOLLOWING ALTERATIONS, CHANGES OR REPAIRS HEREENAFTER SET FORTH MUST BE MADE IN ORDER TO BRING THIS CONFORMITY SI TITLE REQUIREMENTS COMPLETED, CERTIFY COMPLIANCE 2X TO THE ABOVE ADDRESS. AILURE TO COMPLY MAY RESULT IN THE REVOCATION OF YOUR. PERMIT TO OPERATE ANDIOR INES TO $5000. (REV 1233) WHITE STATE - OWNER BLUE. - FAIREEVEZNT OWNER INITIAL El SUPPLEMENTAL KIDDIE 7 ADULT WATER PARK OHIO BEPARTMENT OF AGRICULTURE Rina sarnrv 'e 3995 E. MAIN STREET REYNOLDSBURG, 0310 43063 Phone 614~723-6288 Fax 614-728-6416 . COMPANY LOCATIGN . Lia' CGDE: Satisfactory (U) Unsatisfactory {$11 3* (N) Not Applicable (R) Remarks visible adjacent hazards andfor interferences .. 1. 2. In level position where applicable .. 2. 3. Secure hand holds .. 3. 4- Blocked jacked .. 4. 5. Motors, befits cables guarded .. 5. 6. Stairs walkways-- no obvious hazards .. 6. 7. Fencing, railings and gates in place -. 7. 8. Steps ladders .. 8. 9. Fire extinguishers in place .. 9. 10. No visible unguarded pinch points or hazardous projections. . . . .. .. 10. STRUCTURAL I 11. Visual appearance indicates proper assembiy. II. 12. Visibly free of cracks or excessive wear .. 12. 13. No missing bolts, or bolts of improper grade .. l3. I4. Pins retainers in place .. 14. 15. Chemicals stored-area free ofobvious 15. 16. Motors, clutches controls functioning when viewed .. 16. 17. Brakes stops functional .. 17. 18. Hydraulic system shows no excessive wear .. 18. E9. ELECTRICAL SAFETY 20. Ride transformer generators guarded, ground rod connected .. 21. Electrical boxes have covers, latches signs .. 22. Switches controls operational .. 23. No unattached, unconnected or unguarded fighting detected. . . . . 24. Communication system operational .. 25. Rest periods provided .. 25. 26. Number of guards as required .. 26. 27. Height requirements posted .. 27. 28. Proper warning signs (exit, entrance rules) .. 28. 29. Safety equipment in place .. 29. 30. Signal system functional .. 30. 31. Operator guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervais .. 34. 35. Proper loading, unloading operating procedures followed .. 35. . MISCELLANEOUS SAFETY ETEMS 36. P.F.D.'s available at no charge .. 36. 37. Warning signs (exit, entrance rules) in place .. 37. 38. Water test kit available .. 38. 39. Chlorine residual within specification .. 39. 40. PH within specification .. 40. 41. Electricai supply source .. 43.. Portable Generator Utility Power My signature certifies that I have read the Gamer/Agem' Notice on the reverse side and agree to jieiiy coszpiy was all statutory requirements listed rfierjgon. I COMPLEANCE ALTERATIONS, CHANGES OR REPAIRS HEREINAFTER SET FORTH MUST BE MADE IN ORDER TO BRING THIS EQUIPMENT INTO CONFORMITY ,20 3" no WNERJAGENT SIGNATURE REQUIREMENTS ARE COMP CERTIFY COMPLIANCE AND MAIL PINK COPY TO THE ABOVE ADDRESS. AILURE T0 COMPLY MAY RESULT THE REVOCATION OF YOUR PERMIT TO OPERATE ANDIOR FINES TO 35000. (REV um) wum-1 - PINK - ownsa rsuow - OWNER I INITIAL sopptasrarirat KIDDIE El ADULT WATER RARK QHEG BEPARTMENT OF AGRICULTURE 0 AMUSEMENT Rios sassry 2' 3995 E. MAIN STREET UHIO 43063 H3098 634-7286289 Fax 614--723-6416 Locmon ..-. C0933 (V) S3'fiSf30t0YY (U) Unsatisfactory 3: (N) Not Applicable (R) Remarks #1 1. No visibie adjacent hazards andfor interferences .. i. 2. In levei position where applicable .. 2. 3. Secure hand holds .. 3. 4. Blocked jacked .I .. 4. 5. Motors, belts cables guarded . .. S. 6. Stairs walkways>> no obvious hazards .. 6. 7. Fencing, railings and gates in place. .. 7.5 8. Steps ladders recessed .. 8. 9. Fire extinguishers in place .. 9. N0 visible unguarded pinch points or hazardous projections .. 10. STRUCTURAEJ 11. Visual appearance indicates proper assembly. 12. Visibly free of cracks or excessive wear .. 13. No missing bolts, or bolts of improper grade .. 14. Pins retainers in place .. 15. Chemicais stored~area free ofobvious 16. Motors, clutches controis functioning when viewed .. 17. Brakes stops fiinctional .. 18. Hydraulic system shows no excessive wear .. 29. Air system functional .. ELECTRECAL SAFETY 20. Ride transformer 8.: generators guarded, ground rod connected .. 20. 21. Electrical boxes have covers, latches signs .. 21. 22. Switches controis operational .. 22. 23. No unattached, unconnected or unguarded lighting detected. . . . . . 23. 24. Communication system operational .. 24. 25. Rest periods provided .. 25. 26. Number of guards as required .. 26. 27. Height requirements posted .. 28. Proper warning signs (exit, entrance 8: rules) .. 28. 29. Safety equipment in place .. 29. 30. Signal system functional .. 30. 31. Operator guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervals .. 34. 35. Proper loading, unloading operating procedures followed .. 35. MISCELLANEGUS ITEMS 36. P.F.D.'s avaiiable at no charge .. 36. 37. Warning signs (exit, entrance place .. 37. 38. Water test kit available .. 3 8. 39. Chlorine residual within specification .. 39. 40. PH within specification .. 40. . 41. Electrical suppiy source .. 41. Portable Generator Utility Power My signature certifies falter.' I have read the Owner/Agent Notice can rise reverse side andi?agree to frtliy comply wig: aft statutory requirements Iisted creme. HSHHIGNATURBSQ oosirttancs FOLLOWING ALTERATIONS, CHANGES OR REPAIRS HEREINAFTER SET FORTH MUST BE MADE IN ORDER TO BRING EQUIPMENT INTO CONFORMITY ,20 8" WNERIAGENT SIGNA TITL REQUIREMENTS ARE COMP CERTIFY COMPLIANCE AND MA PINK COPY TO THE ABOVE ADDRESS. TO COMPLY MAY RESULT IN THE REVOCATEON OF YOUR PERMIT TO OPERATE FINES UP TO $5000. 12mg} WHITE A PINK - OWNER BLUE YELLOW OWNER El El SUPPLEMENTAL KIDDIE ADULT WATER PARK OHIO DEPARTMENT OF AGRICULTURE . AMUSEMENT urns SAFETY DIVISION 3 8995 E. MAIN STREET REYNOLDSBURG, OHIO 43968 Phone 614428-6280 Fax 6143728-6416 COMPANY LOCATION 2 mg 33tiSf30'i01"Y (U) Unsatisfactory E3 3 ?h (N) Not Applicable (R) Remarks SITE 3 a 2- No Visible adjacent hazards and/'or interferences .. 1. Z. in level position where applicable .. 2. 3. Secure hand holds .. 3. 4. Biocked &jacked .. 4. 5. Motors, belts cables guarded .. 5. 6. Stairs walkways- no obvious hazards .. 6. 7. Fencing, railings and gates in place .. 7. 8. Steps 8: ladders recessed .. 8. 9. Fire extinguishers in place .. 9. 10. No Visible unguarded pinch points or hazardous projections .. I0. STRUCTURAL ll. Visual appearance indicates proper 12. Visibly free of cracks or excessive wear .. 13. No missing bolts, or bolts of improper grade .. 14. Pins retainers in place .. 25. Chemicals stored-area free ofobvious hazards. . . . i6. Motors, clutches 85 controis functioning when Viewed .. 17. Brakes stops functional .. 18. Hydraulic system shows no excessive wear .. 19. Air system ELECTRICAL SAFETY 20. Ride transformer generators guarded, ground rod connected 20. Electrical boxes have covers, latches signs .. 21. 22. Switches controls operational .. 22. 23. No unattached, unconnected or unguarded lighting detected. . . . . 23. 24. Communication system operational .. 24. OFERATION 25. Rest periods provided .. 25. 26. Number of guards as required .. 26. 27. Height requirements posted .. 27. 28. Proper warning signs (exit, entrance 8: rules) .. 28. 29. Safety equipment in place .. 29. 30. Signal system functional .. 30. 31. Operator guard certifications .. 31. 32. Water ciarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervals .. 34. 35. Proper loading, unloading operating procedures followed .. 35. MISCELLANEOUS SAFETY ITEMS 36. available at no charge .. 36. 37. 'Naming signs (exit, entrance rules) in piace .., .. 37. 38. Water test kit availabie .. 38. 39. Chlorine residual within specification .. 39. 40. PH within specification .. 40. 4} - Electricai supply source .. Portable Generator Utility Power My signqgurp certifies lghat I have read the Owner/Agent Notice on the reverse side and agree to fully comply with all statutory regmremenrs Iisted '""rerin.. . - IX. Insrecrofi SIGNATURE COMPLIANCE ORDERIREMARKS ALTERATIONS, CHANGES OR REPAXRS I-IEREINAFTER SET FORTH MUST BE MADE IN ORDER TO BRING THIS EQUIPMENT INTO CONFORMITY ON 20 WNERJAGENT SIGNATURE REQUIREMENTS ARE COMPLETED, COMPLIANCE AND MAIL PINK 70 THE ABOVE ADDRESS. AILURE. TO COMPLY MAY RESULT IN THE REVOCATEON or YOUR PERMIT TO OPERATE ANDEOR FINES T0 $5000. AGPMD46 (REV lliflli} -- STATE PINK OWNER BLUE - FAERJIEVENT - OWNER 5L) INITIAL SUPPLEMENTAL KIDDIE [j ADULT PARK GHEG AGRECEJIFFEJRE 5; Ci aivrosarsaanr area sararr 8995 E. MAEN STREET fililfl 4-E3968 finesse old-728>>-6289 Fair' 6145728-fidlo we 4-l-9.s-rl.a comm Km; lslamf LOCATEGN 4} 2 coca: (xl) Satisfactory (U) Unsatisfactory 3; gm (N) Not Applicable (R) Remarks 3 SETE -g 1. No visibie adjacent hazards and/or interferences .. 1. 2. In level position Where applicable .. 2. 3. Secure hand holds 3_ 4. Blocked jacked .. 4. 5. Motors, belts cables guarded .. 5. 6. Stairs walkways>> no obvious hazards .. 6. 7. Fencing, and gates in .. 7. 8. Steps ladders recessed .. 9. Fire extinguishers in place .. 9. 10. No visible unguarded pinch points or hazardous "projections .. Ii}. 11. Visual appearance indicates proper ll. 12. Visibly free of cracks or excessive wear .. 12. 13. No missing belts. or bolts of improper grade .. 13. 14. Pins retainers in place .. 14. 15. Chemicals s?ored--area free ofobvious IS. 16. Motors, clutches controls functioning when viewed .. I6. Brakes stops functional .. 17. 18. Hydraulic system shows no excessive wear .. 18. 19. Air system functional .. 19. SAFETY 20. Ride transformer generators guarded, ground rod connected .. 20. 21. Electrical boxes have covers, latches signs .. 21. 22. Switches controls operational .. 22. 23. No unattached, unconnected or unguarded lighting detected, 23, 24- Communication system operational .. 24. 25. Rest periods provided .. 25. 26. 'Number of guards as required .. 26. 27. Height requirements posted .. 27. 28. Proper warning signs (exit, entrance rules) .. 28- 29. Safety equipment in place .. 29. 30. Signal system functional .. 30. 31. Operator 8.: guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervals .. 34. 35. Proper loading, unloading operating procedures followed .. 35. MESCELLANEQUS Sraeara' 36. P.F.D.'s available at no charge .. 36. 37. Warning signs (exit, entrance 8: rules) in place .. 37. 38. Water test kit avaiiabie .. 38. 39. Chlorine residual within specification .. 39. 40. PH within specification .. 40. 41. Electrical supply source .. 41. Portable Generator Utility Power My signemre cerz?fies that I have read the fiwner/Agent ;"EURr3.tice are the re;-terse safe rma' agree 30 flair"): cor:-sply all sslazarorjv requirements Zisted cm. I rm . ft' SIGNATURE 5 THE FULLOWING ALTERATIONS. CHANGES on REPAIRS SET MUST 31-; Main}; IN ORDER TO BRING THIS IELQUIPMENT INTO CONFORMITY PLATE oars COMPLIANCE F19. em fig ml: 'ls-stage fiflwfiff; ii 4 Bogus'? 39:61" rem: rflepfiis-egg" IQ Ea? gzficssasai-W5' 3 ON 20 I CERTIFY Alui, REQUIREMENTS OF THIS ORDER HAVE BEEN FULLY COMPLIED WITH ownsa/AGENT SIGNATURE 9 WHEN REQUIREMENTS ARE COMPLETED, CERTIFY MAIL PINK PX TO THE ABOVE ADDRESS. FAILURE TO COMPLY MAY IN REVOCATION OF YOUR PERMIT TO OPERATE ANDEOR FINES UP TO $5000. mas) warn>>: -- sr.-acre rm}: . BLUE - YEILOW -- OWNER 133$ A SUPPLEMENTAL movie 3 ADULT sears GREG GP ASRECUEJTUEQE SAFETY DEVESEQN 3995 E. MAEFJ GREG 43968 Phone Fax am PLATE RIO SETE CGMPANY kfaeif _lS'iean5f Locariou =1 3 C0333 W) (U) Unsatisfactory E51 (N) Not Applicabie (R) Rernarks :11 EH SERIAL 1. No visible adjacent hazards andfor iliterferenc-es .. 1. 2. In kevcl position where applicable .. 2. 3. Secure hand holds 3. 4. Blocked dcjacketi .. 4. 5. Motors, belts 8: cabies guarded .. S. 6. Stairs wa1kways~ no obvious hazards .. 6. 7. Fencing, railings and gates in place .. 7. 8. Steps ladders recessed .. 8. 9. Fire extinguishers in place .. 9. 10. No visible unguarded pinch points or hazardous projections .. 10. STRUCTEJPLAL 11. Visuai appearance indicates proper 1 1. 12. Visibiy free of cracks or excessive wear .. 12. 13. No missing bolts, or bolts of improper grade 13. 14. Pics retainers in piace .. I4. 15. Chemicals stored-area free ofobvious 15. Moiors, ciutches controls functioning when viewed .. E6. 17. Brakes stops functional .. 18. Hydraulic system shows no excessive we-ea'r .. 18. 19. Air system functional .. 19. 20. Ride transformer generators guarded, ground rod connected .. 20. 21. Electrical boxes have covers, latches signs .. 21. 22. Switches controls operational .. 22. 23. No unattached, unconnecteci or unguarded 'iighting 23. 24- Communication system operational .. 24. 25. Rest periods provided .. 25. 26. Number of guards as required .. 26. 27. Height requirements posted .. 27. 28. Proper warning signs (exit, entrance rules) .. 28. 29. Safety equipment in place .. 29. 30. Sigma} system functional .. 30. 31. Operator guard certifications .. 3 I. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated ioad and dispatch intervals .. 34. 35- Proper loading, unloading operating procedures followed .. 35. 36. avaiiabie at no charge .. 36. 37. Warning signs (exit, entrance rules) in place .. 37. 38. Water test kit available .. 38. 39. Chlorine residue} within specification .. 39. 40. 9H within specification .. 40. 41. Eiectricai supply source .. 41. Portable Generator Utihty Power My signature cerafies tires" 3? have read the Owner/Ages?! Nodes ma rite reverse side or.-i.af grea so of! srazrrzorjr requirements list at. I 'i - at .91: INSPECTC Ionprruaal THE FOLLOWING ALTERATIONS, CHANGES OR REPAIRS HEREINAFFER SET FORTH MUST BE IN TO IS PMENT INTO CONFORMITY PLATE aeouzasmsurs oacra COMPLIANCE one ON 20 I CERTEFY ALE. REQUIREMENTS OF THES ORDER HAVE BEEN FU LLY COMPLEED SIGNATURE TITLE WHEN REQUIREMENTS ARE CERTEFY ANDMAIL PENK TO THE ABOVE ADDRESS. FAILURE TO COMPLY MAY RESULT IN OF YOUR PERMIT TO OPERATE FINES UP TO 35000. mm, "Pius-owes x: RMNITIAL SUPPLEMENTAL jl KIDDIE [3 ADULT rears GEES O. REDE SAFETY EEVESEGN 2 3995 E. stairs STREET @338 asses Fitoaite 6% 4-728-628% Fast oi 6 EATE I 3 Como 9" Locarios 5-J Mvfi E1. CGBE: Satisfactoiy (U) Unsatisfactory 3 ma (N) Not Applicable (R) Remarks SITE 1. No visible adjacent hazards andfor interferences .. l. 2. In level position where applicable -. 2. 3. Secure hand holds .. 3. 4. Blocked jacked .. 4. 5. Motors, baits 8.: cables guarded .. S. 6. Stairs walkways~ no obvious hazards .. 6. 7. Fencing, railings and gates in place .. 8. Steps 8: ladders recessed -. 8. 9. Fire extinguishers in piece .. 9. 10. No visible unguarded pinch points or hazardous projections .. 0. 'Jisttal appearance indicates proper Nut 11. 12. Visiblj-,4 free of cracks or excessive wear .. 12. 13. No missing bolts, or bolts of improper grade .. 13. 14. "Pins retainers in place .. 35. Chemicals stored~area free of 15. 16. Motors, clutches 62; controis functioning when viewed .. 16. 17. Brakes stops furictionai .. 17. 18. Hydraulic system shows no excessive wear .. I8. 19. Air system 19. 20. Ride transformer generators guarded, ground rod connected .. 20. 21. Eiectricai boxes have covers, latches signs .. 21. 22. Switches controls operational .. 23. No unattached, unconnected or unguarded fighting detected. . . . . 24. Communication system operational .. 25. Rest periods provided .. 25. 26. Number of guards as required .. 26. 27. Height requirements posted .. 27. 28. Proper warning signs (exit, e;1t1'anee dz rules) .. 28. 29. Safety equipment in place .. Z9. 30. Signal system functional .. 30. 31. Operator guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. 35. Operating within designated load arid dispatch intervals -. Proper loading, unloading operating "procedures followed .. 22. 23. 24. 34. 35. MESCELLANEGEJS 36. P.F.D.'s available at no charge .. 36. 37. Warning signs exit, entrance ifs; rules) in place .. 37. 38. Water test kit avaiiable .. 38. 39. Chlorine residual withili specification .. 39. 40. PH within specification .. 40. 41. Electrical source .. 4i. le Generator Utility Power My sigrzatzzre cerrifies rear have read rs'-re Owner/Ageizr ftforiee or: the reverse sfde and agree so caarrspig: ref .31 at'! szarurory requirements iisted THE FOLLOWING CHANGES OR HEREIN AFTER SET MUST BE TN (JRDER TO BRING TH 1S INTO CTONFORMITY PLATE REQUIREMENTS COMPLIANCE DUE 7 team? iseaf ?reife.--1; rog?talraaf tilm?i L?c.e.r5 9' ON 20 I ALL REQUIREMENTS OF THIS ORDER HAVE BEEN FULLY COMPLIED WITH AGE: 3 [146 (REV IZJOS) OWN ERIAGENT isromgroap. WHEN REQUIREMENTS ARE CERTIFY COMPLIANCE AND CQEZ T0 ABOVE. ADDRESS. TO COMPLY MAY RESULT IN THE REVOCATION OF YOUR TO OPERATE ANIMOR FIN ES UP TO $5000. TITLE WHITE - PINK - OVVNEP. BLUIE -- YELLOW -- OWNER 5'71? "i INITIAL if' if CE SUPPLEMENTA 1. KIDDIE ADULT P?aflfifi GE-EEG flit" as . Amnsaraanr sins sarsrr 3 8995 E. MAEN asses Fiaone are-rsaszso Fax we 1:2. CQMFANY kin; 5' i i (ma! Locmrors .3 EUR033: S3ti3f3'3t0Y)' (U) Unsatisfactory E3 32 (N) Not Applicable (R) Remarks a 1. No Visible adjacent hazards andfor interferences .. 1. 2. In level position where appiicable .. 2. 3. Secure hand hoids .. 3. 4. Blocked dzjackcd .. 4. S. Motors, baits cables guarded .. 5. 6. Stairs walkways no obvious hazarttis .. (1. Fencing, and gates in place .. 7. 8. Steps ladders recessed 8_ 9. Fire extinguishers in place 9. 10. No visible unguarded pinch points or hazardous projections .. I0. 31. Visual appearance indicates proper 11. 12- Visibly free of cracks or excessive wear 12, 13. No missing bolts, or bolts of improper grade .. 13. 14. Pins retainers in place .. 14. 15. Chemicais stored-area free of obvious hazards15. 16. Motors, clutches controis functioning when viewed .. 16. 1'7. Brakes <92; stops functional .. 18. Hydraulic system shows no excessive wear .. 18. 19. Air system functional .. 20. Ride transformer (E: generators guarded, ground rod connected .. 20. 21. Electrical boxes have covers, latches signs .. 21. 22. Switches controls operationai .. 22. 23. No unattached. unconnected or unguarded lighting 23. 24. Cotnmunication system operational .. 24. 25. Rest periods provided .. 25. 26. Number of guards as required .. 26. 27. Height requirements posted .. 27. 28. Proper warning signs (exit, entrance rules) .. 28. 29. Safety equipxnent in place .. 29. 30. Signal system functions} .. 30. 31. Operator guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervals .. 34. 35. Proper loading, unloading operating procedures foliowed .. 35. 36. available at no charge .. 36. 37. Warning signs (exit, entrance 3: rules) in place .. 37. 38. Water test kit available .. 39. Chlorine residual within specification .. 39. 40. PH 'within specification .. 40. Eiectricai supply source .. 41. ?o1'tabIe erator Utility owe: My signature cerzzfies rear' strove ream' flee we side emf agree to fafly eoeapfy of! srarzarorjy requirements c" 3., MW- ownsaxaofiirrsionatoas Inseatirfit siowaroafi. - I 3' caosaraarea.a.a:s THE FOLLOWING ALTERATIONS. os HERFJNAFTER sar Foam BF. ORDER To INTO CONFORMITY REQUIREMENTS oars COMPLIANCE DUE ON . '20 I CERTIFY ALI. REQUIREMENTS OF THIS ORDER HAVE BEEN COMPLIED VVITH OWNERJAGENT SIGNATURE TITLE WHEN REQUIREMENTS ARE COMPLETED, CERTIFY COM PIJANCE TO THE. ABOVE ADDRESS. TO COMPLY MAY RESULT IN THE REVOCATION OF YOUR PERMIT TO OPERATE ANDFOR FINES UP TO $5000. PINK-OWNER De: le5P~ (mass at INITIAL 3' 9 ff] SUPPLEMENTAL {fl KIDDIE 'ea/arses PARK GREG isfiRlCUlJi'lJ??E. aaiosaarnnr sins MWSEQN 89% MAEN STREET GEES 43068 Faerie ole-728-623% Farr sia--72s>>-eats oars Li" El ADULT PLATE NO CGMPANY king: lama-i Locarron 3 Cfififiz (Ni) Satisfactory (U) Unsatisfactory 3: it (N) Not Applicable (R) Remarks 3 Sara 3 1. No visible adjacent hazards anclfor interferences .. 1. 2. In level position where applicable .. 2. 3. Secure hand holds 3_ 4. Blocked &jacked 4_ S. Motors, bolts cables gnartied .. S. 6. Stairs no obvious hazards .. 6. 7. Fencing, railings and gates in place .. 7. 8. Steps 8.: latlders recessed .. 8. 9. Fire extinguishers in place .. 9. 10. No visible unguardeti pinch points or hazardous projections .. 10. 1 1. Visual appearance indicates proper ll. 12. Visibly free ol"cracl SUPPLEMENTA 1. Moore ADULT ease GREG . asxttisastasr mos sewers' omstou 3 3995 E. REYNGEJESBEJRS, GEES asses Phone 614-728-628%} Fax 6 we seams Locartors 2' C9333 S3llSf3CT0fy (U) Uiisatisfactory (N) Not Applicable Remarks srra 5 1. No Visible adjacent hazards aitdior interferences .. 1. 2. In level position where applicable .. 2. 3. Secure hand holds .. 3. 4. Blocked &jacEted .. 4. 5. Motors, belts cables guarded .. 5. 6. Stairs 6: Walkways no obvious hazards .. 6. Ir'. Fencing, railings and gates in place .. 8. Steps 8.: ladders recessed .. 8. 9. Fire extinguishers in place .. 9. 10. No visible unguarded pinch points or hazardous projections .. I0. STRUCTURAEJ 11. Visual appearance indicates proper E1. 12. Visibiy free of cracks or excessive wear .. I2. 13. No missing bolts, or bolts of improper grade .. I3. 14. Pins 8: retainers in place .. 34. 15. Chemicals stored-area free ofobvious E5. 16- Motors, clutches controls functioning when viewed .. E6. 17. Brakes :51: stops functional .. 17. 18. Hydraulic system shows no excessive wear .. 18. 19. Air system functional .. 19. 20. Ride transformer generators guarded, ground rod connected .. 20. 22. Electrical boxes have covers, latches 3.: signs .. 2 . 22. Switches controls operational .. 22. 23. No unattached, unconnected or unguarded ligiitiiag 23. 24. Communication system operational .. 24. %?ERfia'E'i0N 25. Rest periods provided 25. 26. Number of guards as required .. 26- 27. Height requirements posted .. 27. 28. Rroper warning signs (exit, entrance rules) .. 28. 29. Safety equipment in place .. 29. 30. Signal system functional .. 30. 31. Gperator guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervals .. 34. 35. Proper loading, unloading operating procedures followed .. 35. 36. P.F.D.'s available at no charge .. 36. Warning signs (exit, entrance rules) in place -. 37. 38. Water test kit available .. 38. 39. Chlorine residual within specification .. 39. 40. PH within specification .. 40. 41. Electrical supply source .. 41. Portable Generator Utility Power My signature certifies may .?sat=e ream' rise Uwrrer/xflgerzr or-'3 rite reaerse side or: agree to fairly) compijrairirft oi? Hfifidfafgf requirements Eisred is con. :2 at hm .- I THE FOLLOWING ALTERATIONS, CHANGES OR REPAIRS SET MUST BE MADIE IN OR DER TO INTO CONFORMITY 13LATE REQUIREMENTS DATE COMPLIANCE DUE 7 a: .- I --.4 in oififiei-<>72s-ans oars 3. K5 is lam-.3 a C933: (xi) Satisfactory (U) Unsatisfactory (N) Not Applicabie (R) Remarks SHE 1. No *-aisibie adjacent hazards andfor interferences .. . in level position where applicable .. . Secure hand holds .. . Blocked jacked ., . Motors, beits cables guarded .. . Stairs no obvious hazards .. . Fencing, railings and gates in place .. . Steps ladders recessed .. . Fire extinguishers in place .. . No Visible unguarded pinch points or ha2'.a1'dous projections .. 11. Visual appearance indicates proper 12. Visibiy free ofcracks or excessive wear .. i3. No missing bolts, or bolts of improper grade .. 14. Pins retainers in piace .. 15. Chemicals stored-area free ofobvioiis 16. Motors, clutches controls functioning when viewed .. Brakes 8; stops fiinctionai .. i8. Hydraulic system shows no excessive wear .. 19. Air syszem functional .. 20. Ride t1'ansforme..r generators guarded, ground rod connected .. 21- Eiectricai boxes have covers, iatebes signs .. 22. Switches 3: controls operationai .. 23. No unattached, unconnected or unguarded iigliting 24. Communication system operational .. 25. Rest periods provided .. 26- Number of guards as required .. 27. Z8. 29. 3G. 31. 32. 33. lcieight requirements posted .. Proper warning signs (exit, entrance rules) .. Safety equipment in place .. Signal system functional .. Operator guard certifications .. Water clarity satisfactory .. Operating at designated speed .. 34. Operating within designated load and dispatch intervais .. 35. Proper loading, unloading operating procedures followed. . .. .. Sis? i'E'Ea-ad 36. available at no charge .. 37'. Warning signs (exit, entrance rules) in piace .. 38. Water test kit avaiiabie .. 39. Chiorine residual within specification .. 40. PH within specification .. 41. Electrical supply source .. Gcim?aal i 3 L) [1 5301.715 ADULT 22 0' . LL: 2. La RED THEME 18. 36. 37. 38. 39. 40. 41. Portable Generator Uti Power My signature cemfies rim! I have read fire 02-mar/Aigeaf {'r'ora'ce air; rise r'evaese side aasd agree so coaa,a{i' wile air' szasasoiy requirements iisted I THE ALTERATIONS. OR REPAIRS BE MADE IN ORDER TO BRINCE INTO (IONPORMITY siomroag I PLATE o/qa COMPLIANCE one i {3 .3mr?J arm maxi gaffe;-A 8 fiwo -I "if Qfiil CERTIFY ALL REQUIREMENTS o1= THIS oaosa HAVE seen FULLY COMPLIED WITH SIGNATURE 'rm.s WHEN RBQUXREMENTS ARE COMPLETED, CERTIFY COMPLIANCE ?(2fX TO THE ADDRESS. FAILURE TO COMPLY MAY RESULT IN TI-IE REVOCATION OF OUR PERMIT TO OPERATE ANDIOR FINES UP TO $5000. MSR-I045 (REV mics} PENK - -- YELLOW -- SUPPLEMENTAL [3 WATER PARK 91-119 OF AGRICULTURE E9. 0. RIDE sannry nivrsion 2 3995 E. MAIN STREET OHIO 43068 Phone 614-728<<-6289 Fax 614-728-6416 COMPANY memos 2 CQDE: (V) Satisfactory (U) Unsatisfactory 32 (N) Not Applicable (R) Remarks 3 sire is 1. No visible adjacent hazards andfor interferences .. 1. 2- in ievel position where applicable .. 2. 3. Secure hand holds .. 3. 4. Blocked jacked .. 4. 5. "Motors, 'oeits cables .. S. 6. Stairs walkways-- no obvious hazards .. 6. 7. Fencing, and gates in place .. 7. 8. Steps iadclers recessed .. 8. 9. Fire extinguishers in place .. 9. 10. No visible unguarded pinch points or hazardous projections .. IO. STRUCTURAL 11. Visual appearance indicates proper ll. 12. Visibly free of cracks or excessive wear .. I2. 13. No missing bolts, or bolts of improper grade .. I3. 14. Pins retainers in place .. 14. E5. Chemicals stored-area free ofobvious I5. 16. Motors, clutches controls fimctioning when viewed .. 16. I7. Brakes stops functionai .. i7. 28. Hydraulic system shows no excessive wear .. 18. 19. Air system functional .. I9. SAFETY . 20. Ride transformer generators guarded, ground rod connected .. 20. 21. Eiectricai boxes have covers, latches signs .. - 21. 22. Switches controls operational .. 22. 23. No unattached, unconnected or unguarded iight_i_r1g detected. . . . . 23. 24. Communication system operational .. 24. OPERATIQN . 25. Rest periods preV'i"ti'e'd. . .. 25- 26. Number of guards as required -. 26. 27. Height requirements posted .. 27. 28- Proper warning signs (exit, entrance ruies) .. 28. 29. Safety equipment in place .- 29. 30. Signal system functionai .. 30. 31. Operator guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. - 33. 34. Operating within designated load and dispatch intervais .. 34. 35. Proper loading, unloading operating procedures foilowed .. 35. NHSCELLANEOUS SAFETY ETEMS 36. avaiiable at no charge .. 36. 37. Warning signs (exit, entrance rules) in piace .. 37. 38. Water test kit availabie 38. 39. Chiorine residual within specification .. 39. 40. PH within specification . .. .. 40. 41. Eiectricai supply source .. 41. Portable Generator wer My signature cerfifies that I have read the Owner/Agerrf Notice on the reverse side and agree refuiiy er'! sreturory requirements listed thereon. I .. Inseacr?n stcnarttee FOLLOWING ALTERATIONS, CHANGES OR REP I SET FORTH MUST BE MADE ORDER TO BRING THIS EQUIPMENT INTO CONFORMITY ON 20 SI ATURE TITLE REQUIREMENTS ARE COMPLETED, CERTIFY COMPLIANCE AND Mart. PINK cow To THE ABOVE ADD AILURE TO COMPLY MAY RESULT In THE REVOCATION on YOUR PERMIT TO OPERATE FINES UP TO 3500:}. (REV -- STATE-1 PINK - OWNER BLUE - FAIRJEVENT -- OWNER aw. 1 IMTIAL Cl I KIDDIE ADULT vvarsn oHIo DEPARTMENT OF AGRICULTURE O. AMUSEMENT RIDE SAFETY DIVISION 2 8995 E. MAIN STREET REYNOLDSBURG, OHIO 43068 fltone 614-<<728-6280 Fax BATE CGMPANY 9' LOCATIGN 7 5 . CODE: (xi) Satisfactory (U) Unsatisfactory gt (N) Not Applicable (R) Remarks . gal 5 1. No visibie adjacent hazards and/or interferences .. . 1. 2. In level position where applicabie .. 2. 3. Secure hand .. 3. 4. Blocked jacked .. 4. 5. Motors, belts cables guarded .. 5. 6. Stairs walkways no obvious hazards .. 6. Fencing, and gates in place ., 7. 8. Steps iadders recessed .. 8. 9. Fire extinguishers in place .. 9. 10. No visible unguarded pinch points or hazardous projections .. I0. STRUCTURAL I 1. Visual appearance indicates proper I1. 12. Visibly free of cracks or excessive wear .. 12. 13. No missing bolts, or bolts of improper grade 13. 14. ?ins retainers in place .. I4. 15. Chemicals stored-a1'ea free ofobvious I5. 26. Motors, clutches controls functioning when viewed .. 26. 17. Brakes stops functional .. 17. 28. I-Iydrauiic system shows no excessive wear .. 18. 19. Air system 19. ELECTRICAL SAFETY 20. Ride transformer generators guarded, ground rod connected .. 20. 21. Electrical boxes have covers, latches signs .. 21. 22. Switches controls operational .. . .. .. 22. 23. No unattached, unconnected or unguarded 1' hting detected. . . . - 23. 24. Communication system operational .. 24. OPERATION 25. Rest periods provided .. 25. 26. Number of guards as required .. 26. 27. Height requirements posted .. 27. 28. i'roper warning signs (exit, entrance rules) .. 28. 29. Safety equipment in place .. 29. 30. Signal system functional .. 30. 31. Operator guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervals . . . . . . . .. 34. 35. Proper loading, unioading operating procedures foliowed .. 35. SAFETY ETEMS 35. P.F.D.'s available at no charge .. 36. Warning signs (exit, entrance mics) in place .. 37. 38. Water test kit avaiiabie .. 38. 39. Chlorine residual within specification .. 39. 40. PH within specification .. 40. Eiectricai supply source .. 41. Generator Utility Power My signature certifies that I have read the Owner/Agent Notice on the reverse side and agree to fulfy compiy wait}: ad'! statutory requirements listed tflezgom If SIGNATURE IN ECT SIGNA ORBERIREMARKS FOLLOWZNG ALTERATIONS, CHANGES OR REPAIRS HERETNAFTER SET FORTH MUST BE MADE IN ORDER TO BRING THIS EQUIPMENT INTO CONFORMITY ON sron TITLE REQUIREMENTS ARE COMPLETED, CERTEFY COMPLIANCE TO THE ABOVE ADD AILURE T0 MAY RESULT IN THE REVOCATION YOUR PERMIT TO OPERATE ANBEOR UP TO $5000. AGRJQ45 (REV WHITE STATE PINK. -- OWNER BLUE -- FAERIEVENT YELLOW OWNER 71596, IKITIAL SUPPLEMENTAL KIDDIE ADULT it warm PARK QHIO DEPARTMENT or AGRICULTURE . AMUSEMENT RIDE SAFETY omsron 3 3995 E. MAIN REYNOLDSBURG, OHIO 43958 Phone 614-728-6280 Fax 614-728-5416 oars . 9" . 5 r.ocArtoN CODE: (NI) Satisfactory (U) Unsatisfactory (N) Not Applicable (R) Remarks 1. No visible adjacent hazards and/or interferences .. 1. 2. in Zevel position where applicabie .. 2. 3. Secure hand holds .. 3. 4. Blocked jacked .. 4. S. Motors, belts cables guarded .. 5. 6. Stairs walkways>> no obvious hazards .. 6. 7. Fencing, railings and gates in place .. 7. 8. Steps ladders recessed .. 8. 9. Fire extinguishers in place .. 9. 10. No visible unguarded pinch points or hazardous projections .. 10. STRUCTURAL E1. Visual appearance indicates proper ii. 12. Visihiy free of cracks or excessive wear .. 12. 13. No missing boits, or bolts of improper grade .. 13. 14. Pins retainers in place .. I4. 15. Chemicals stored--area free ofobvious I5. 16. Motors, clutches 8; controls fimctioning when viewed .. 16. 17. Brakes stops functional .. 17. 18. Hydraulic system shows no excessive wear .. 18. 19. Air system functionai .- 19. ELECTRICAL SAFETY 20. Ride transformer generators guarded, ground rod connected .. 20. 21. Electrical boxes have covers, latches signs .. 21. 22. Switches controls operational .. 22. 23. No unattached, unconnected or unguarded lighting detected. . . .. 23. 24. Communication system operationai._.. .. 24. GPERATIGN . . in 25. Rest periods proviitii?fd. .. 25. 26. Number of guards as required .. 26- 27. Height requirements posted .. 27. 28. Proper warning signs (exit, entrance 8: rules) .. 28. 29. Safety equipment in place .. 29. 30. Signal system functionai .. .. 30. 31. Operator guard certifications .. 31. 32. Water clarity satisfactory .. 32. 33. Operating at designated speed .. 33. 34. Operating within designated load and dispatch intervals .. 34. 35. Proper loading, unloading 32; operating procedures foliowed .. 35. MISCELLANEGUS SAFETY ITEMS 36. P.F.D.'s available at no charge .. 36. 37. Warning signs (exit, entrance ruies) in place .. 37. 38. Water test kit avaitabie .. 38. 39. Chlorine residual within specification .. 39. 40. PH within specification .. 40. 41. Eiectricai supply source .. . . . . . . .. .. 41. Portable Generator Utility Power My signature certifies that I have read the Owner/Agent otice on the reverse side and agree to fatty comply alt' statutory) requirements owzwasrao NATURE in XNSPECT asrowa s-trtsanca osesaxassasaas FOLLOWZNG ALTERATIONS, CHANGES OR in SET FORTH MUST BE MADE IN ORDER TO BRING THIS EQUIPMENT YNTO CONFORMITY .4 ON WNERJA ENT TETLE REQUIREMENTS ARE COMPLETED, CERTIFY '1 0 THE ABOVE ADD AILURE TO COMPLY MAY RESULT IN THE REVOCATION 0? YOUR PERMIT TO OPERATE ANDIOR FINES TO S5000. AGR4045 (REV mos} warns -- STATE - OWNER BLUE - FAKIUBEENT YELLOW - OWNER 4,99