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Based on observation and interview, it was determined the facility failed to maintain vertical openings between floors, on two of seven floors.

Findings Include:

1. Observation on March 16, 2016, revealed the following vertical opening deficiencies:

a) At 1:10 p.m., in the third floor 3-West Telecom room there were seven pipe conduits penetrating the deck above that were not sealed using an approved through-stop penetration system.
b) At 1:45 p.m., in the fourth floor 4-West Telecom room 4132 A there were eight pipe conduits penetrating the deck above that were not sealed using an approved through-stop penetration system.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the unprotected vertical openings.

Based on observation and interview, it was determined the facility failed to maintain smoke barriers in two instances, on one of seven floors.

Findings Include:

1. Observation on March 16, 2016, revealed the following unsealed smoke barrier penetrations:

a) At 9:53 a.m., on the first floor, above smoke barrier doors near room 1172, there was a 3/4 in flexible conduit that was not sealed going through the smoke barrier.
b) At 10:02 a.m., in first floor room 1192 B, there was an unsealed penetration in the smoke barrier above the ceiling, on the back wall.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the unsealed penetrations.

Based on observation and interview, it was determined the facility failed to maintain recycling receptacle storage requirements in one instance, on one of seven floors.

Findings Include:

1. Observation on March 16, 2016, at 10:15 a.m. revealed a recycling receptacle, greater than 32 gallons capacity, was stored in the ground floor corridor, near room 332.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the receptacle was stored in the corridor, outside of a protected hazardous storage area.

Based on observation and interview, it was determined the facility failed to maintain oxygen storage requirements in one instance, on one of seven floors.

Findings Include:

1. Observation on March 16, 2016, at 1:40 p.m. revealed there was greater than 300 cubic feet of oxygen stored in 4th floor Clean Holding Room 4225 A. This room did not meet the requirements for oxygen storage.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the oxygen was not properly stored.

Based on observation and interview, it was determined the facility failed to maintain electrical wiring requirements in one instance, on one of seven floors.

Findings Include:

1. Observation on March 16, 2016, at 10:01 a.m. revealed a refrigerator was plugged into a surge protector in 1st floor, Room 1192 B.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the electrical wiring issue.

Based on observation and interview, it was determined the facility failed to maintain vertical openings between floors, on two of seven floors.

Findings Include:

1. Observation on March 16, 2016, revealed the following vertical opening deficiencies:

a) At 1:10 p.m., in the third floor 3-West Telecom room there were seven pipe conduits penetrating the deck above that were not sealed using an approved through-stop penetration system.
b) At 1:45 p.m., in the fourth floor 4-West Telecom room 4132 A there were eight pipe conduits penetrating the deck above that were not sealed using an approved through-stop penetration system.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the unprotected vertical openings.

Based on observation and interview, it was determined the facility failed to maintain smoke barriers in two instances, on one of seven floors.

Findings Include:

1. Observation on March 16, 2016, revealed the following unsealed smoke barrier penetrations:

a) At 9:53 a.m., on the first floor, above smoke barrier doors near room 1172, there was a 3/4 in flexible conduit that was not sealed going through the smoke barrier.
b) At 10:02 a.m., in first floor room 1192 B, there was an unsealed penetration in the smoke barrier above the ceiling, on the back wall.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the unsealed penetrations.

Based on observation and interview, it was determined the facility failed to maintain recycling receptacle storage requirements in one instance, on one of seven floors.

Findings Include:

1. Observation on March 16, 2016, at 10:15 a.m. revealed a recycling receptacle, greater than 32 gallons capacity, was stored in the ground floor corridor, near room 332.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the receptacle was stored in the corridor, outside of a protected hazardous storage area.

Based on observation and interview, it was determined the facility failed to maintain oxygen storage requirements in one instance, on one of seven floors.

Findings Include:

1. Observation on March 16, 2016, at 1:40 p.m. revealed there was greater than 300 cubic feet of oxygen stored in 4th floor Clean Holding Room 4225 A. This room did not meet the requirements for oxygen storage.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the oxygen was not properly stored.

Based on observation and interview, it was determined the facility failed to maintain electrical wiring requirements in one instance, on one of seven floors.

Findings Include:

1. Observation on March 16, 2016, at 10:01 a.m. revealed a refrigerator was plugged into a surge protector in 1st floor, Room 1192 B.

Interview with Facilty Personnel on March 17, 2016, at 2:30 p.m., confirmed the electrical wiring issue.