2024-0339 CERTIFICATE OF OCCUPANCY ONLY office Use Only
c. Zo.z4—off
APPLICATION Permit#:
To ofQreensbury Permit Fee:$
(4114)
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8206 or 518-761-8205 www.queensbury.net
**This application is for occupancy only, with no work requiring a building permit**
BUSINESS INFORMATION:
I
Name of business: ;Pods -S i,cts CA-li-p___€
Business Address (including suit , space, etc.): -Ka \ cd_ 5 Lc? L 1T Fi,,___- ,__
(3
cts—c (R-e-A--g 9 --A- 0—u AAA , kke,-pjn.s (,i,l' , ill-7 .4-y
Detailed explanation of business (attach a separate piece of paper, if necessary):
kA0-4 vl P�1/tovt(,tips "(,J A___C . ?aik l�(,3, CAI -Q-ci<-1�►'N� �
* * *Please provide an accurate layout of your space showing
all walls, exits, stockrooms, rest rooms, counters and fixtures
on a separate sheet of paper* * *
IMPORANT: The business owner is responsible for keeping exits clear and maintaining exit
signs and emergency lights. Fire extinguishers, fire sprinkler systems, and fire alarm systems
require annual inspections by an outside contractor and the corresponding documentation
must be provided to the Town of Queensbury Fire Marshal's office. Fire extinguishing systems
found in kitchens and gas stations require semi-annual inspections. Any violations noted
during an inspection require immediate corrective action and a re-inspection.
. I\' V Pli-ro:NjoCur-LQ°13ti9EIENSBURY
les.- � �Applicant name• y � � r�
Applicant signatur •�� L �3UILDfiNG& CODES
Property Owner name: R�y,,of) V" t p04... 'Q- 9..... ---
Property signature: Date: , 2•Y
p Y Owner ,� a
Certificate of Occupancy Only Revised September 2022
/104)
Thwn of fucrnsbuty
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
EMERGENCY CONTACT INFORMATION
**THIS FORM IS USED TO ASSIST EMERGENCY SERVICE PERSONNEL WHO MAY BE CALLED TO YOUR
BUSINESS AFTER HOURS. PLEASE BE SURE THE CONTACTS LISTED BELOW ARE WILLING AND
AVAILABLE TO REPSOND DURING OFF-HOURS TO ASSIST POLICE AND/OR FIRE PERSONNEL IN
GAINING ENTRY TO YOUR BUILDING.**
PLEASE BE ADVISED THAT FAILURE TO ASSIST EMERGENCY SERVICE PERSONNEL MAY RESULT IN
DAMAGE TO YOUR BUILDING BY POLICE AND/OR FIRE PERSONNEL.
Date:
Business Name: 5, �
1, -e/i'lCThri,,,
--9,__ l- yv-'---
Business Location (including suite,space,etc.): M. — G Z•g`4°‘
G 5'-0416.Y ,
a'- voAl t J f z_3-0--jz
Business Phone#: 1 8 — eS 7 d 0 c 7
1. Business contact name: \/ 1/kk. T 1�--- LV A—
Main Phone:_( n(1 ) 7 �CIOZI ; Secondary Phone:_(
1
Contact is coming from what town/village? At
2. Business contact name:
Main Phone:_( ) ; Secondary Phone:_( )
Contact is coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
FI REMARSHAL@QUEENSB URY.N ET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE
Certificate of Occupancy Only Revised September 2022
Fown ofCmrnsbury
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):2)t; 'jn Ma-
Mailing Address, C/S/Z: \(o AA 3itW5Vt 5? , �ZO
Cell Phone: (3'/ . ) 227 —43 i/ Land Line: ( 1 )
Email:Ma 2.h;y; b q( i(Ida,cam .
• Business Owner(s):
Contact Name(s): c0`'1'"`(2 WigoxV1Z__
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _(
Email:
• Property Owner(s):
Business Name: -;M bkv/�(oenzn4-
Contact Name(s): ,„c ��� L h o
Mailing Address, C/S/Z: 91-
u,,.� 9
Cell Phone: _(51 ) 7' 6 ZZ67 Land Line: _( ) 79 602,C
Email: An&1'-1•--- /c,a 6 ® Z" ttitla(-Pla.c "J C_(2ell
Contact Person for Compliance in regards to this project: v sk
Cell Phone: l S LII/L5a6 — oo La i-Liaer"
Email: C_f,
y �
Certificate of Occupancy Only Revised September 2022
4,0
b,✓
Foes Marshall
Office of the Fire Marshal
742 Bay Road, Queensbury,NY 12804
518-761-8206/8205 www.queensbury.net
PLAN REVIEW
959 State Route 9
2024-0339
I have reviewed the submitted drawings for the above project; the original
plan review still stands. _
1)Verify Fire extinguisher locations&inspection. (Verify on Final)
2) Locks/latches shall comply with 2020 NYSFC.(Verify on Final)
3)Verify operation of existing exit/emergency lights.(Verify on Final)
4)CO Detection, (Verify on Final)
5)Verify Knox Box key. (Need on Final)
6)Verify aisles&storage(On Final)
7) Need info on Curtains, need to know if Flame resistance or Flame Spread on Material(received all
Documents)
8) Have to Maintain 18" of Clearance for Sprinkler system,also get with Sprinkler Company PFP and Andrew to
make sure the system can handle the Additional Fire Load. (Waiting on letter from sprinkler Company)
9)Flooring materials/need specifications.(Included on Submittals)
10)Fire alarm system will need to be Modified for adequate coverage in all rooms.(System staying the same)
11)Need to know if a cooking appliances will be in building or layout of kitchen area if having a kitchen (No
Kitchen)
Tyson Converse
Deputy Fire Marshal
•
E' :4
Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 1 of 16
DONGGUAN JINCHENG DECORATION MATERIAL CO.,LTD
FLOOR 2,WEIPAI SCIENCE PARK,WU BAWEI ROAD, SHENXIANG VILLAGE,QISHI TOWN,
DONGGUAN CITY,GUANGDONG PROVINCE,CHINA
Sample Description : PVC SHEET FLOORING
As above test item and its relevant information regarding to the submission are provided and confirmed by the
applicant. SGS is not liable to either the test item or its relevant information, in terms of the accuracy, suitability,
reliability or/and integrity accordingly. /'
Sample Receiving Date : Jul 17, 2021 ,
Test Performing Date : Jul 20, 2021 to Aug.23;2021 \ \
Test Performed : Selected test(s),as requested by applicant. ..,
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Signed for and on behaif of ��
SGS-CSTC Standards\Technical Services Co., Ltd. Shunde Branch
�" rl
Peter Zhao
Authorized Signatory
Test Result Summary
Uniese othorviloo'egreed-in.Valttn0,this document la.isaued"by'thoompany aubiect.to lts.'Genorel Condtttons•ot_ServIc prfnfod:
�i'. overleaf,available on request or ecceselbleat hit:iwww a a a row.nd-Cenditbns a and,fareteetrenicformat documents,_
=r.c subiect,to:Ternro'and Conditions'for Electronic cumenaa p a,c3men a en-Cgndtttonp/F9[ma-@-ppcuRranta6px
Attention.in drawn to the Iimitotlon-of;liabtllty tndemniflcetion and s l flan issues a ned• atom.Any;notder at t is-document is.
�& advised thatinforrtiatton cotrtsteed hereon're}teote tha.Company'a flndines at:the time•of he InteNnntlon onl1yy and within the limits of-
- .'''. `"'� Client's In81fUCrtgexe tr.any.The their ripanys sale ruaponsibtltyyto to tts Client-hnd curee ecument does not'exonerate reprod;to a:
rye tronsacdon.trom exsroisln*.a(t rights and obllgatlons.under,fho iransec0on;documenta.,Thla dooumont:wnnot be reproduced_
occept.In•tuit;wlthout-prtor.wrltten epprovatoMire Company.Any unauthorized ntteratlon,forgery;or fataltidetion of.tha content•or
iti'$t`r� j`ft1 i,' '' • 'appearance of.this document is unlawful and offenders maybe prosecuted.to the fullest octent'of fire law.Unless:ottterwlaa'atatod the.
`ttfu tskTest; 3rirkns raeults shown inthleteutreportreferonlytothesemptstaJtestod and aucl,eernpta(eiare retained for30daysonty.': -..
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Meriguif of the.SGS Group(SGS SA)
J
Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 2 of 16
`-.'No ' =, " •,Test'itein -- Test(s);Requested ' . ', ..Results)-'.` . -;':Coir ments',..'
Part EN 660-2:1999+Al:2003&EN
1 1 Wear resistance 649:2011 Wear group: P /
Fire classification of
construction products
Part and building elements- •' ") Classification:
1 EN 13501-1:2018 /: , /
2 Part 1: Classification j Bn-s1
using data from ' ", :,
reaction to fire tests .^ .\
With refereriee>to'IEC 62321 \ \' ,
RoHS Directive(EU) 4:2013+A1'201 \,7, IEC 62321
2015/863 amending 5:2013, IEC 62321\7 2:2017�;lEC \;. -
1 \ \ ,�: , Fail . /
Annex II to Directive /62321 6:2015 and'IEC,.62321 `` .-":,
2011/65/EU 8:20,17,analyzed by ICP.\OES, UV
\‘Vis aiid.GC MS
Part Migration of Certain ,,
2 /1''• ``�^-, EN.71,3:2019+A1 2021 '', , Pass /
3 Elements" • -' ,� / ',-
Pentaclilotnphenol ' ,:,/ °w. '
3 ''0,- :"'"BS EN 14041:2018 Clause 4.2 Pass /
Formaldehyde '.`\r `.` "`,,. \-\
4 -'. -° ..:.-. ,, BS`EN 14041:2018 Clause 4.3 El /
,` Emission K- \.
Formaldehyde .'\ •
5 ` . \'
\ `� '�; EN 13986:2004+A1:2015 El /
Emission ``ti•�'°�
\" ''. \.\ Technical class
Part Dynamic�''Coefficient of
1 ` -,:•;.;?,. EN 13893:2002 DS /
4 Friction
/ f Pass
For further details, please refer,to the•following page(s)
Test Information:
-- Liaises ottioiwiho'agre6d;In writing,this document Is Issued tip'the Campany:autr eit,}nIfs 6edotal-Cdodidoos of vice printed-
.'- ,Vi ,`i; ; . overleaf,available on request or accessible at h:twvrw de.ca an rm- d- onditions�apxand,foretootrenic format documents,.
. -3'. 4•y subiom,to.Tenns.and Conditions for Electronic oaumen Te v_t ye,$(ty t`on�T'g t pnQ-�ondtN�fferma e mant asrn�.,
.'.' s Attentbn is'drawn to the!imitation of liability indemnification an urtsdicttor, ssues daflnea ere fn:7fay.older o tit r acumen s
„_its;• - '% , advised that tntormation contained hereon,,rotiscta the Company's findings at the time"of ha,teterventteh only_and within the limits'of.
Cient's lnstructionf.:tf any.`the Company'a:soie,responsibiU ts.to Its Client and.t is documentdoea not exonarote'parties.to`a'
�, :t. •.' y?. • transaction;tram oxerclsing-a8 their rights and-ebUgetions:ander tholraneactton documents.Tbla-docu nent_cannot:be reproduced"
j t 3: E oxcaptin.PoII:eithout priorWrilten approval of the Company.Any Unauthorized eteratton,forsery-ot fatsif caftanof.the content of
i1;?i r'.i�1)tit': appearance of this document is unlawful and otfende(s'may be prosecuted.to thafuUeet extent of the law.Unless othefwise stated the'.Lepecii4Tesposf.ror. results shown to thtstestreportrefer only to trio templets)tested end such sempte(s)are retained tar30 daysonly.-, ,_
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Memberof the.SGS f ith p(St3S SA)`
Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 3 of 16
Sample Description: See photo
Test item:Wear resistance
Test method: EN 660-2:1999+A1:2003 and EN 649:2011 •
Test condition:Weigh the specimens to an accuracy of±0.1mg after conditioning. Load each wheel with a weight
of(1±0.01) kg. The flow of abrasive is (21±3)g/min.Abrade one specimen during 5000 revolutions,
with a break for weighing after each cycle of 1000 revolutions, and then test the two remaining
/ '
specimens. If, however, the first specimen is abraded through before 5000 revolutions, discard it
and test the two remaining specimen in cycles of 2d0 'revolutions stopping the test after 2000
revolutions or when the specimen is abraded through.\•
Calculate the average mass loss.Fm,in milligrams er 100`revolutions for each specimen as follows:
.,
,
Fm = tot X 100 �, '„ ,.
n � . .
\ \,: ,,
Calculate the loss of volume for each specimn,f eor 100;revolutions as follo�ws:
F (- r� �"
Requirement of EN 649:2011: \
.'''>:, ." '•' •,r`.Requirement"s fqr wear group
Characteristiet-� ,";- " ,: ` ' ` ,.r .:. .",,..
•
T�- :,3../,` - P',,,� ' M F
Volume loss Fv(mm3)/100revolutions r', ") Fv__s2.0\ 2.0<Fvs4.0 4.0<Fv_s7.5 7.5<Fvs15.0
Test result: -a "-„ "' :: --.,„ _`,
/"':.'," TestresUlt \'r , Wear group
,'ffv=2.8mm3/100revolutions''. P
�', N \ N.,--oe,
Note:All test specimens were cut fr:om'the sample:
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Untose:ottiervrbse"agreed in:Writing;:this document Is foamed by the Company aublect,to•.Its General:Ccndttbont of.Service printed
l lj,o overleaf,availsbie on requestor.ecceselbia at htto:/twww,aps.cem�rt��en�ivT�ar,mrs•a d-Candittnns and,tor electronic format documents,
ti i 1,?'4 l sublect to Tetme eed Coadiiione tot Electronia.6ocuments.et it d l dop mlon?Ierm a'ndnth.
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_'�. '�' Client's
that Information contained hereon'ratsole.the Company's findings atths time of lta'bnterventlon only estaner within the limo of-;. Client's lnetruatioos.:tf any.-The Company's oaie ligati responsibility loth r,the is Client and.this;document-doesmnott carnerate'partlos to e
" 4.y F^� trensecUen fmrrr-exemising:ali.their dghta--aed"obblgetlons:undet;the trensaodon°documonta.-Thla document cannot be reproduced°
`• ?- i. oxcept:in full:without':prior written approval,of the Company.Any-unauthorized alteration'forggery�or.faisIticaUon of.the content or
..A4Et!,iyt fl} �.=y appearance of this document is unlawful,and offenders may.be prosecuted,to the tutest extent of the law,Unless aiherwisa stated the
he�nkaVrastilurera4 results shown inthboteatrepoitreleronlyto the sample(s)tested end soon semple(a)"are retained far30daysoniy,:..`
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Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 4 of 16
Photo Appendix:
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overleaf,available on mall eat or accessible at hitp://enew,enceo u.a at.,rm., tpI. enditions a' and,tofelectrenic.fermatdocOments•
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toxlaenereleffrf,reli treeertaisiiirgtleittiAlteriatZeini'clintions'onderrecf.transaction-documents„Thie document cannot be reprodecodi
Company.Any-Unauthodzed alteration,'forgery:or.faistricatIon'ef.the content or.
appearance of this-doormen'le unlawfuli anda catt the d to thefullest extent of the law.Uniess'ettrerwisestated Me-
wl:046 eaw2Sireices 4 .. results shown In ties test report refer only to the atrigtrsiead9eTadeasuacthleemplefe)ere retained for 30days ority.-:- - -
. ,
......te Ationtedn:TO check.the.stitharitreity or teitino I in ape lion raPert&ciettricate..plaake contact.e&,at totoOfrane0a.a'ai,t4at
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Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 5 of 16
Part 2(SGS Ref.No.: SDFS2107004663FF)
__ _ _ TESTS AND RESULTS
Test Conducted:
This test is conducted as per EN 13501-1:2018 Fire classification of construction products and building
elements-Part 1: Classification using data from reaction to fire tests.
And the test methods as following:
1. EN ISO 9239-1:2010 Reaction to fire tests for floorings-Part 1: Determination of the burning behaviour
using a radiant heat source.
2. EN ISO 11925-2:2020 Reaction to fire tests-Ignitability of building products subjected to direct
impingement of flame-Part 2: Single-flame source test. <'
Kr:Mounting and fixing(For EN ISO 9239-1:2010): ./ "',- .
Fibre cement board meets the requirement of EN13501-1{of'Class A2-s1 d0,with its density about 1800kg/m3,
thickness about 8mm, is as the substrate. ,,�'" \.`
The specimens were fixed mechanically to the substrate
Test Results: /\ ` \
Test method Parameter \s \f Number of tests Results
The mean•:value'for_the criticarheat flux
(CHF)frog the"s`ame orientation,'': 8.0 kW/mz
EN ISO 9239-1:2010 Smoking,measurement ,. ::,'*,,, 3 0
135.35 /o x min
Integratedbsmoke.value � a
, . -Commentstan$d,Obseryation~ \(,:\,,, Charring
EN ISO 11925-2:2020/ '', ` \"�, \ ,• . "s ``',,.;k":'•'
c ., `ems%<_ 150 mm within 20's : 6 Yes
Exposure= 15 s 4 \, \ \ /
Remark: ''\ : ` '`
1). Above value is the mean for the critical flux(CHRand/or HF-30)from the three same orientation
specimens:•''`".." "'� ti
./.. / `--,„„ -. \ <-*--'' '''::'' \ ,-;\
Classificait[on and direct-fieid.of application ,ication '''s.. )
This classification has been carved oufin accordance with EN 13501-1:2018
C lassifications;-.. \\:,: \ `�,
Fire,behaviour ''' Smoke production
i
Di ! — s 1
Remark: /
The classes with their corr ponding"�fire performance are given in Table 2.
Reaction to fire classification i's`based on the 7-step scale of Alit to Fn,where Alf'is good and Fit is bad.
Statement:
The test results relate to the behaviour of the test specimens of a product under the particular conditions of the
test;they are not intended to be the sole criterion for assessing the potential fire hazard of the product in use.
s. Uniasa`othervgao'agreed tn'ivdttnn,this document la lssusd by the'Company subject"to Its Gehorat,Conditions of SerNce,prinled-
1 ;k" ft.-, overleaf avallabte.on requaot or accessible at htt 1 w s.co m en rm• d• ndnti n a hand,,ffoorselectronic-ffon0noatxtdooacuments,
'{n" ' .�f r subject Io Terms and Cgndidons:tor,Eteetronte. acumen at.11ttp_: ,g o Insane de ne ere n, ny o der a ocument Is:
'' r " advised that Info u&ion'.contalned hereon reheats'the Companya findings at:the time of its intervontton only and wtthln the-itmlte of
`' `°'; + -- ' Client's tnatructions,tf.any.•The'Company's sole responsibility Is,to'its:Client and this'docutnent:does not exonerate'parties to.a=
? tt " ` tranaauttdn'trom-exorcising a0.their rights'and obiigetlons:under;the traneaeton dacuments,Thia document cannot bereproduced'
'•'tat" ` except;tn fuli.:vtltheut°pdorwrltten approval of-the Company.Any-unauthorizad nheradon.for�oary or.fatslflcatlon of-the-content or:
ffffF�5555,�"'t$'tf;'Ik)7:'jjj:l : appearance of thin document is unlawful and spenders maybe prosecuted to thafulleat ettant of the tow:Unless ottiertitae stated the
t rSTtturjjtaius, ° reaulteehown In thin teatreportroferonly,to the sampiets)teatedendauch eampte(s)are retained for30 days only.:;; '
v, :. . ;d, etrontlen:in ctiect,thc'auth .bully of tasting t inspocttan.report tk.cartiticnte;.please contact us at teloghana7SSj,S3fFT'-
.;Yr 9-0d3,greoiklitNAoacltuckr• ags,cam- .
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Member of the.SGS Group(SGS SA)
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Test Report Nu.SQHL2107012920H| Date:AuQ24,2031 Page 6mf1g
VUonminq:
This classification report does not represent type approval or certification of the product.
The test laboratory has,therefore, play no part in sampling the product for the test, although it holds appropriate
references to the manufacturer's factory production control that is aimed to be relevant to the samples tested and
that will provide for their traceability.
Table 2'C|a0000uf reaction to fire performance for floorings
C|ono Testmothod(o) Classification criteria Additional classification
A10 EN ISO 1182" '
and Amg5UY6; and �
tf=0(ie. nosustainad�aimingy� `�
EN ISO 1718 PC8:�2 '
PCS�2
PC�� 1 � '\
PCs:52
A2n EN ISO 1182° A755D"Cand '
or Am!55O96and
��,f0^o.
EN |GO1710 '
and rN' u»and
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PC3g3.6(NJ/�g�� ',"�
EN ISO Q23Q'1 " Chdoa| 8.0 Smoke pmduoUon»
/ '
Bo EN |GOO238'1(�
'�CriticalOux �
Smoke production«
and
BN ISO 11025-2 h. '
Co \(Critical fl Smoke production«
tind/'
ENI,ISO 925'2»: Fs m within 2Uo
Dn EN |GO ° \ -Critica|Oun'�t3.UkW/m2 Smoke production n
and X` \ �
EN ISO 11 i5Ummwdhin2Os
Exposure \^ ) /
Ev EN ISO 11Q25'2��' '\^'' �Fn515Umm within 2Un '
Exposure= 15o `��
Fn � `~
EN ISO 11025'2»� Fn> 15Omm within 2Uo '
Exposure= 15e
ovl"d that information contained hereon:rebactsTat Company's findings at.tho time of Its Intervention only and within th.'I"to Of
Imit
8 to'IS ClIaWand this axoneraWpartloa to a:
Client's any.-The Companies"Is.responsibill
at the'transaoltion,documents.Thlo'dMarlorif cannot be reproduced-
or
pl,la Nil.without,prior written approval of the,Company.Any,unouthorized agaratlori;'fo, / " conterit,or
spp4�arlco ofthIs docBmantli unlawful and offenders maybe prosecuted to thafulleatextent I Wbs,flasfian a
..rosufts shown In this testreport refor only to the sample(s)tested and such ajample(s)are retained WSO days only."
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•
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Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 7 of 16
a For homogeneous products and substantial components of non-homogeneous products.
b For any external non-substantial component of non-homogeneous products.
For any internal non-substantial component of non-homogeneous products.
d For the product as a whole.
e Test duration=30 min.
f Critical flux is defined as the radiant flux at which the flame extinguishes or the radiant flux after a test period
of 30 min,whichever is the lower(i.e.the flux corresponding with the furthest extent of spread of flame).
9 s1 =Smoke 5 750% minutes;
s2=not s1.
h Under conditions of surface flame attack and, if appropriate to the,e d use application of the product, edge
flame attack r/-'. /
_ SAMPLE 1_N_FORMATION`AND'PICTURES _ _
Thickness of test specimen: 2.1 mm / - ` ' \ ''N
Density of test specimen: 1.8 kg/m2 / / N" "•
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th it rl,y overleef,avalteblaonraqusetorecceeetbieathttp:Rwww,sns.o en! rme_g d- audition as and,taretectronleformatdocuments,.
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;_' , '',�, - , Attased t le drevm to on tn of reontty l cte the Cam panyM.findings
sates'a It Drain. n""Only end Tibia Ms limin s
mob' '' - advised that information contained hereon ra}tale the Compnny'e flndtnge et:ihe time of Its intervention only within limits of
'. Client's Inenundone.If any:The Campeny'a"antereoponstbinttyy ts.to Ito Client n documents.
exonerate petties;to a'
', trannecUort.tmm"axerctstng all their rights and obhgeliens.under the-transaction documents.Thta document cannot-be reproduced;
�' tr4€Y;,, `=' except in felt.wlthout"prtorwritten epprovet.et.Ute Company.My unauthorizad"altetaton,forgery er,fetnlUbatton of the eantent or:
t�.°r`t} J ir'1ti ..s' appearance of Ibis'document Is unlawful and offenders'may be prosecuted to the fullest extent of the few:Unless othetwfee stated ttte
lrepttllfoSTetbxgSm'at rasultsshowninttdstestreportrefer,onlytothsaample(e)testedandsuchsampte(e)areretainedfar3Udaysony:._
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Member of the'SGS Group(SGS SA)
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Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 8 of 16
Part 3 (SGS Ref.No.: CAN21-147906)
Test Results :
•
Test Part Description :
SGS Sample ID Description
CAN21-147906.001 Light blue material(surface)
CAN21-147906.002 "PVC sheet flooring"
t:,,; /
//:-,''•„ r:,,,
Remarks : (
(1) 1 mg/kg=0.0001% ..,i''''' \-;"
.,•• , \
(2) MDL=Method Detection Limit
;/: \
(3) ND= Not Detected (< MDL) / •••••• m \
(4) "-"=Not Regulated
\\''< .\ / .c-
\- \ e• '...) .N.
,... +, \./"...,.., )
RoHS Directive(EU)2015/863 amending Annex II to Directive 2011/65/EU
\ : .
\. ...4.-,-,4. ,.. ,
.:,,,.:
Test Method : With reference to IEC 62321-4.20134401017 IEC 6321.75:2013, IEC 62321-7-2:2017 , IEC
'„
62321-6:2015 and- IEC 62321-8i2017, anely,zed,.„Joy ICPOES , UV-Vis and GC-MS .
\
,, \'\ / ' '. \\'')
,/,' ..!,./ , . ''''''', /N., '",f,,
Test Item(s) ''', ;":': Cimit, 7(c-unit '''',..mbL 001
,-,
. Cadmium(Cd) ..!.,,,,,,,, 100.'•.:,-. rng/kg 2./ ND
Lead(Pb) :\ / .••1_,,,, 1000 \,mg/kg 2 ND
Mercury(Hg) ,.---7','" ;;,.•'--- '''\\X-:'," , '-;;":1000 \rrig/kg 2 ND
, .. ;-/' ,,,,
Hexavalent Cliro,yrriitirli-(OiVI ''\,. ''.'‹ -1000:,,,mg/kg 8 ND
,•.‘, <-.• :N,
Sum of PB6s' ,:t '',..„ ,.,..., N ihe
... 1000-',. .mg/kg ND
Monobromotlpnyl \\ N
mg/kg 5 ND
,
\.. •• .
Dibromobiphenyl\.\\ •••..: \
\'.-.2.‘ -\-...
mg/kg 5 ND
\
Tribromobiphenyl ... ';'\\
• -,•,,' .,)
mg/kg 5 ND
Tetrabromobiphenyl\'‘,..,•:.\
3'
''' - mg/kg 5 ND
Pentabromobiphenyl i - mg/kg 5 ND
Hexabromobiphenyl \\.,,,,,A •••••'..!"/ - mg/kg 5 ND
,‘, •r...;-'
Heptabromobiphenyl K/ - mg/kg 5 ND
Octabromobiphenyl - mg/kg 5 ND
Nonabromobiphenyl - mg/kg 5 ND
Decabromobiphenyl - mg/kg 5 ND
Sum of PBDEs 1000 mg/kg - ND
Monobromodiphenyl ether - mg/kg 5 ND
Dibromodiphenyl ether - mg/kg 5 ND
...0, ,,,4.,„. .; Unteee'othenViee.: ptied in wrItfnb,this dectireent le isetierr by the„CoUipanyt etibleci*Its,•Gaherif,CancIttrenti Uf Set:elcetirInted.
"""........\
.:' ' Cilartre,Insliuctions,trnany.Ane tompaenny'U sole reeponsibeity.le:to'its Client and'th1Cdocument.doee,not exonerate partlesAU-a.;
d
I. ''''T-I'' ''i '',!• ,--:, , traneaction porn-oxeicising-all their rights and ohligetions;.under.the.transacUon,docuinens.•Tble;documruttcannot he.raprodUutui
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1' 5: -*-i's1:641'','. Attention,i, tldirrmtitho%%maitre:Careen reliab-"iretYlleIngrit"g1;%%,4:11,,e,°art'thrZ.I.VA Int=i-Iii.V.n-loy7,4r°41intirlf.lra!if'
L.74-?:!;ttlAO„.iiiiilii'fl '''''.-;„I.
rarget.euttittaluoCegioern!TsmeenrirtaArard:ItZecors.inerbye.pArnoysZlatrit:editursrg%tronieWtrnttc;s%WirIcetiVtg:-
V..,wre,,,,,,Twijr1$arrbri .4 r; rosette shown In trite teskreport reforoati to the semptete)testau end such Sample(S)Ole retained tor30 dOsonty; ....;.1:•'.'.,
I. , :•-, .,-.0. ,. Atteotioprro"chock tlyeeptbentleitypfLestirap I inepktion report g oortittOzto;Meese oonteeepe.ot tetepheno:pg,•75S)4301,
4-,...7. i •,1442;or email:ct.1,..p.c, chn{Mr.gF..r.pra: . " . „ . .., , .
(
-,.:R::,..:7,••,..v4i,,. .,4*,,,sc4,c14..imir;Fig*Ntomtisfootti*Oriweoar*re,i441.52i3?3 ile#457)#048:,f.(8647t0270* iiY,-;v*r-Oi;*01.:0
',..-4,f),**1.. . ..:_. • - -.4.51.t0.0thuittodotioxAgoilittiariek-4iltdif.ii:54!f(60-157)22'8C088 i(136-751)204665.8;:i:4i:Cli*giei:tialiC..
'monber&ilia SGS Group(SGS SAY:
•
•
Test Report No.SDHL2107012920HI Date: Aug 24,2021 Page 9 of 16
Tribromodiphenyl ether - mg/kg 5 ND
Tetrabromodiphenyl ether - mg/kg 5 ND
Pentabromodiphenyl ether - mg/kg 5 ND
Hexabromodiphenyl ether - mg/kg 5 ND
Heptabromodiphenyl ether - mg/kg 5 ND
Octabromodiphenyl ether - mg/kg 5 ND
Nonabromodiphenyl ether - mg/kg 5,-, ND
Decabromodiphenyl ether - mg/kg /5.:,) ND
Dibutyl phthalate(DBP) 1000 mg/kg/ ,50 y ND
Butyl benzyl phthalate (BBP) 1000 mg/kg- .., 50., ND
Bis(2-ethylhexyl) phthalate (DEHP) 1000 mg/kg 50, •`,125242#
Diisobutyl Phthalates (DIBP) 1000 / mg'/kg 50 ` `ND
Notes : �-,.•
. �'
(1)The maximum permissible limit is quoted from`Ro19S Directive'(EU)2015/863 *;,
(2) IEC 62321 series is equivalent to,EN 62321 serer:a.,, :.•-' -'
https://www.cenelec.eu/dyn/www/f?p=104:30:1742232870351'101::::FS P_ORG_I D,FSP_LAN G_I D:12586
37,25 ,•\e \., i;•,
(3)The restriction of DEHP, BBP, DBP;and DIBP shall apply to''medical devices, including in vitro medical
devices, and monitoring and control instruments, including jindustriel monitoring and control instruments,
from 22 July 2021. / '\, "'* `�
(4)#= Exceed the'li"r"riitr ' ";�"' 'f `"
EN 71-3:2019+A1:2021 -Migration of Certain Elements(Category III: Scrapped-off toy material)
Test Method Wth�reference to EN.•71-3 2019+A1`:2021,, analysis was performed by ICP-OES.
/.','Chromium (VI):was analyzed by IC-UV/hC-ICP-MS.
"E
Test Item(s) \ \' '-,,;- ''.Limit Unit MDL 001
Soluble Aluminum'(AI) , s'v`„ ''\ 28130 mg/kg 50 ND
Soluble Arsenic(As) k• `, G 1 47 mg/kg 10 ND
Soluble Boron B I. ',
( ) 1- 15000 mg/kg 50 ND •
Soluble Barium (Ba) 18750 mg/kg
Soluble Cadmium (Cd) \\sf` 17 mg/kg 5 ND
Soluble Cobalt(Co) 130 mg/kg 10 ND
Soluble Chromium (III) (Cr III) 460 mg/kg 5 ND
Soluble Copper(Cu) 7700 mg/kg 50 ND
Soluble Mercury(Hg) 94 mg/kg 10 ND
Soluble Manganese(Mn) 15000 mg/kg 50 ND
Soluble Nickel(Ni) 930 mg/kg 10 ND
Soluble Lead(Pb) 23 mg/kg 10 ND
i Unless otherwise agreed to writng;this document le.leaued'by the.Conipany subject to Its:General.Cenditians:of Service,printed:
nt evades available on request or accessible at tt afwwwe a e rm• d-,andhtons�aep,and,foretectmnlcfonnatdacumente
o "sub}out Za;Tonne;and Candtttans;tor Elechontc, omen a a errmrps-on-CQQnd t}pae/�gtma-p-Dgcu�6+ant.asp
,,t,� Attention:Ie drawn to the ltmitstton of liabili tndamelllcetion an u sd� ,on B th ei twtd f 7 do f 1��� ��� i7r"�. ty d sues a no er n.Any; er,a th s� cumon s.
i 1 "' > - embed that.Inforrtialion contained hereon,reflects the Company's findings at.the time of Its:interventron-onlyY and within Co limits of
'- "''`'.3 '. Clients Iaetructions;If any.The Company,'a sole responsibility.In to,its Client and this"document duos not:exonerate:parries Jo'a
„ .. treneectien.rom examining all their rights and obligations:ender the traneec0aa dccuments.•Ttlla'documem cannot.be reproduced:
i ;..,.' .. . except in:fuiwithout prior,written approval of•the.Company-Any unauthorized alteration;forggery",or falatttce0on of the cement or:
•. a Trt` appearance of this do test repo is unlawful and etfender te)to be prosaeuted.to the fulieat extant of the taw;Unless otherwise stated the
pa3.Te gfciritn�p fssuttoehownInthieteatreportreferoniytothesamplaCe)taelodandsuchsempte(s}areretainedfar30daysony „;
,., ';:.:"..; "-., fy mums tom To chile k thv'orthant€city5i toatiag r 6cSpect€oit.report 6;:aurti6i:at.:,pladt;a contact an at teteph'saae:(So 7tt1}s3a7"
t •�. '`r' ..?443,oreniait:GN.ttoerheets s a:corY
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Member of the SGS Group(SGS SA):
Test Report No.SDHL2107012920H| Date AuQ24,2021 Page i0of16
Soluble Antimony(Sb) 560 mg/kg 10 ND
Soluble Selenium (Go) 460 mg/kg 10 ND
Soluble Zinc(Zn) 40000 mg/kg 50 ND
Soluble Strontium (Sr) 50000 mg/kg 50 ND
Soluble Tin (Sn) 180000 mg/kg 4.9 ND
Soluble Organic Tin 12 mg/kg ND
Soluble Chromium (VI) (Cr V|) 0053mg/kg 0.020 ND
Comment PASS
Notes
I.Soluble Chromium (111)=Soluble Total Chromium Soluble Chromium (VI)
2 Confirmation test on soluble organic tin is notconversion, does not
exceed the soluble organic tin requirement as.solecified in EN 71 3:201'9+Al-2021
Pentachlorophenol (PCP)
Test Method With reference muS Eml performed byGC'ECDTest Item(s) Limit 00 1
Pentachlorophenol ND
Formaldehvde Emission
Test Item Unit MQL 002
Formaldehyde Emission (in air) 0.050 ND
Notes
Attention Is drawn W.thel limitation of liability Indemnification an- U 0-t 00$$Us$.-0 me at
advised that infotniation contained hereon robects the companys findInis at the time of its:intervention 4nland within,the,limfs�of
tronsaction from exercising all their rIghts-and:obilliations un er,th6 transaction documonts.,This documen(cannot be,reproduced-
'W"ted to a 9ast extent c,the low..Unless otherwise state the;
nd such somple(s)are retained for3D days only,-, ''-* '-4
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Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 11 of 16
EN 13986:2004+A1:2016-Formaldehyde Emission
Test Method : With reference to EN 717-1:2004, analysis was performed by UV-Vis.
Test Item(s) Unit MDL 002
Formaldehyde Emission (In air) mg/m3 0.050 ND
Notes : (1) mg/m3= milligram per cubic meter / /
(2) Reference Limit: EN 13986:2004+A1:2015
Formaldehyde class El:. 0.124 mg/m3 air . ,
k. •.,/ \ -\.,.
Formaldehyde class E2: >0.124 mg/m3 air \-J ',. •N
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•:.• uiiidc,e cthiepirii'ed in writina,,this documard hi issued by the Company subject.ba its-General.aondltiOna,of Satiacaltrintetl,
01 4R4:1-`;-''' overleaf,available on requentor accessible at h ://wvvw .co en rms.. 4. °editions a and,far...electronic foimat documents,:
,,:_, ,,giy„,...•.. 101,105,tc,ife.rrrat,andp,nditionit'tor'qoctronle; omen a. n I ' n.
the Ilmitation.of',ability,indemnalcation,an t,a on ewes no.. ere n..ny,o a(o a ocument 8,
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'Ik"'''i • ---7.,,,,:',': 64ntSLItilite2idicg;:t7n6t;.1111rggelp_ryn reer;de_h4C;TtfteHltlYir flgt9t117°6,Intr.:'dtg',I...,%!,Nr.rRrl,,,_"1,._end waraltb!_ein'pa"litta"mtP8 C'af.
',',. -.....,' ,, •:'. t''',. 1.. transatuon.from exarciaing.ett:their' righteransfooputnivn.iunuara.the•trenseecuonandocUmitnuru,inie Ite=ment cane°,be-manage&
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1 t-7?,,,,,i,,,,,,,,....;,4„,,,.....,J,X4,1 except-in foil.'without prior-written.approvatof the Company.Stir Unauthorized&titration,forearitir-faleificittiort of.tho.Content or
is,),,,t:tilz.,Ta4 :: ',11.0gasnaghtitgatgtz;V,s,:itZlfontli:.trgAresCeTaitgdPargesculic=tptgifeltraersetgaiggirNodwaYitilgig."116'Nf!"""."!
!,,,Attentitaatty chic",the::,inibentlelty,of lasting f in50Z.than teoart S aartitit ate,.please bontaat tie at telnpl7P.i:.0$4-est)77,:
,,,,;,1443,brpmell;CpocanebbkVaga.cont, , ,
•!,''''S,Ctl:41.gtkiirit'W tS.CI-1.-t. 111 .P.4104,4bile#2*44,04110,0.44/10 i*1.(80-.4.0.) 2:0*;ti(86:46400668.K8 ii'it6'*-i414roligi.
'• ...,,!..i,4411: ,,,,,. . -- ' ,. .1t4011.Tt.81011100.004101,0011Vittiii_s4.1711-.Atifiiii:5.,S!Wa-•1,0104570.805sta'••f,(664510Eiii§350 4,',. ..Ctrtn*SciS:Cei11:;
,,
Mo;fiberef thoSGSaiiiiiir(SGS SA): .
•
Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 12 of 16
ATTACHMENTS
PbICdMgICr61PBBsIPBDEs Testing Flaw Chart
1)These samples were dissolved totally by pre-conditioning method according to below flow chart
(Cre''and PI3Bs/PBDEs test method excluded).
Sample Preparation
4,
Sample Measurement
iPb/Cd/Hg PBBs/PBDEs lee,
Acid digestion with Sample solvent lir -
microwave/ extraction Nonmetallic Metallic
hotplate 4 material material
iir Concentration/ ABSIPCIPVC Others '
Filtration Dilution of Boiling water
I extraction solution 4 4` extraction
4► 4, Dissolving by Digesting at
Solution Residue Filtration ultrasonication 150-160°C
Adding 1 5-
' 4, + + diphenylcarba
1)Alkali Fusion/ GC-MS Digesting at Separating to zide for color
Dry Ashing development
2)Acid to .4, 60°C by get aqueous
dissolve DATA ultrasonication phase itir
i UV-Vis.
ICP-QES/AAS pH adjustment
DATA
DATA Adding 1,6-
diphenylcarbazide for
color development
UV-Vis
DATA
at. Untous:othoiwlao:agreedte'wrllm',thIe docuhtpt:s'ineuodby the Compenyil'en ctanais"Caeitoiei.Coodtdobs:re 3ardtee'Drinitt,
.- 'Cb, €t r' avadoaf,available onrequeator acceaeIbto at hap•f wwwa a.ea an rma-"d- andktons a and,forelactrontetormatdocamonts,"
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��'<- -A` ndvined that Information contained"'Pliers the Company'e findings at the tlmo of.tts'interyontion only and within thotluntta of
-_' _ , Client's instructions.•tf any:She Company's sole.roaponnlbhlty Ialto tie Cnentand thin document doofOnot'exonerete'portion to a.
'•' ` tronsoctiomfrom examining all.their rights and.obligatlone;undder the.tranaactian documents..This,documenf-cannot be.repraducdd"
f' I,i,,, ,t p;. except"In fun:'wltitout•prtorwritten appro'ral:of the Company.Any unauthorized:altemtton.forgery or falelficatlon office content or: '
"t t .t`e r f•f , 'appoaranna'of thin document Is unlawful end atfendors maybe prosecuted to the futleat extant of the law.Unlese'otharwlao elated the
Ecs;nGik�nn B�1edr nr{ctt4 results shown In this teatteport color only to the uemp'e(e)toots end suohsempte(s)era retained for3g days'ony:� -
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Member of ttio SGS Giciiip(SGS SA): .
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Test Report No.SDHL21O7O1292OHI Date:Aug 24,2021 Page 13 of 16
ATTACHMENTS
Phthalaftes Testing Flow Chart
Sample cutting I preparation
v
Sample Measurement
V
Solvent extraction
V
Concentration/Dilution
tL
Filtration
GC-MS
1
DATA
7—.777
• Vi a.. Unless attmairles'agiaed'to Wddnp,this doctiment-ia Issued by the:Company aub[act.te tts.Gsttaral Condit of et Senile*"iiilniod'
- h� sf ;'- avertesf,available on request or at asalbto athttpIt aw,,eg,o en rm- rid-Conditions. -and,for"etectronFcformstdacumonts,
�.tr� subject to 3erme:and COoditions-tcr Electtvnte 66uu uttienttss: t ems an n Qp� g1t
' Atfeniton fa drawn td the]Imitation of liability.lndamniiietlonan s ct'Rpda'di sues do nod: ere it. ny y ar o is oou�ment€s'
, , • "" Clieennt s instructions.-if any.The:Company's ale reaporalblller yy le-to e:Cillen-and his documennt does not enxonerate�e U parties
yi . 'r` ty treploauo d
trans l ttt.(from axarctslnp atF their rights and obifgeompa;undery-tl transasod nit curnents.;Thla'document cannot be raprodnt or
,, t,. ,. `-=� ,excapt:ln full;wittrout.priobwritton approvet,af:the Company.Any-unautherized alteration;forgery or fatelficatloept.dta content or.
f.4-z(?it(lr`ffi4f: appeorsnte of this document Is unlawful and otienders'may.be prosncuted.ta tha'fulleet extent of the law.Unless'otherwise stated titer
i ice ago kgkg5frec4.;4 .rosultsshown in thiateatropertreferanly teats eampista)tested end such sompfe(s}are retatned far3edaysonty,-"_�
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Test Report No.SDHL2107012920H1 Date:Aug 24,2021 Page 14 of 16
Sample photo:
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Remark:This test was subc`ontJ�actedtto SGS-CS
TC Standards Technical Services Co., Ltd. Guangzhou Branch.
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Ifnioss Mtiotw(o,agreed fr.tyritt gt:thin documenttic`issued byr the'Caii pe:iy'nub[aat.talea.Ge si�af Conittttai's of Service printed:
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avetlehmannagaesler s'cceaetbte at' d•Ayyru,,ags:e•e ar rn aadhlons,ae and,tur,dtectronlotcrmetdecumonte,;
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`� : ,,. ��• Attention Ia itto atta,fha ltmttat on of liability'IndemnIlesue.ma u,a .oe nuuea deina•-Giare a. `y-holder e[.ttt u,peide ent.in
advised thet.intdrmeUan'contetned herepn roheote the Gompenfe nndir u at.the rims of lea intervention only and within the timtta ot:
`" `� `' .^' Ctient'a tnubuctione,if any,-me Company;s ecio.raopanaibtifttyy:Es:ta ita,Chant and this'doaumentdoee"not exonerete;parttas,to-e
,- ' 's' traneacuon from-exerctaing'att thou nghtn;and obligetlons yndet;the transacrlah dooumgnte.7trla docement;eannot be.raprodeond.
=' `^ ' excepi:in.tuft:withoui-prtera•ritten approval at the Cot4pany.My-unanhottzed eitgrntlon,.forgery.or fa,,,,, tton'o(•thetwntent•or
,•` 1;'''"�ti{i JJ ' . epeeargthce nFihte document is untawtul and yifenders etny be praseauted to.the falloutententof the,taw.Unlosa otherwise elated the
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Test Report No.SDHL2107012920HI Date:Aug 24, 2021 Page 15 of 16
Part 4(SGS Ref. No.:XMIN2107008029CM)
Summary of Results:
No. Test Item Test Method Result Conclusion
Dynamic Coefficient Technical class DS
1 EN 13893:2002 0.54
of Friction Pass
Note: Pass: Meet the requirements; ,
Fail: Does not meet the requirements; /
/
!: Not Apply to the judgment. £r i
Original Sample Photo: '�` "
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1 Onions othsrwlea agreed'in.wrttIng,this docuinant'ts isaued'byttie Company eub}ectto Its Geneial:Conditions of Service'printed;
` A ft y overleaf,available on requeat or.eccasalbls at http./lwww,4ga.co en r rms• t¢- endtifons and,for etoctronicfoimetdocumonts,-
c li li 4 ' subtend to Terms and Conditions for Electronic Documents at'1IIp cots r s•an Cgndit�n/�arm,-a Doc�umo f.aw�sx.
,,ddvv y<` ;" . ^ _ Attention la drawn to the limitation of liability,indemnification and'tu s on ta"sues meth.A'ony holder.a tti a. ct dacumen to
•` "`,l'."=: advised that information contained hereon re lecta'the Company's findings at the Urns of its intervention only end withld tlto limits of,
.": Client's instructions,It any.The Company's'aole,responsib51ty ta:to its Client and this document,-does,not'exonerate. es;to a;
u ,; :i' treneacace;from oxerclaing:ab their,rights and obligetions.undder the transecgon documents.,Thia document cannot be reproduced
44 ,.,f; except kn,tuII;without prior written approval-of the Company.Any unauthorized alteratIon;'torgeryor fatslfcation at the content or.
, .irtk� WE; appearance of this document is unlawful and eftenders'mey ha prosecuted to tha'fuilest extent of the law.Unless otherwl a stated the
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Meriter of tile SGS Group(SGS SA}`
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Test Report No.SDHL2107012920HI Date:Aug 24,2021 Page 16 of 16
Test Item: Dynamic Coefficient of Friction
Sample Description: Flooring, See photo ,
Test Method: EN 13893:2002
Test Condition:
Specimen dimension: 1000mmx1000mm, cut from original sample
Testing surface:see photo
/•>t
Testing speed:020m/s ;)
Test result:
Result Requirement in EN 14041:2004/AC:2o06 Conclusion
Dynamic coefficient of The floor covering intended to be used in dripandtinon-
T.
friction: contaminated conditions`,shal have a dynamic efficient
-',, .k •\ Technical class DS
X Direction:0.56 of friction of>_0.30 when tested ex-factory under dry
Y Direction: 0.54 conditions in accordance with EN 13893 and shall be \.6 \ Pass
N� / k,- s
Result: 0.54 ,declared as techn al�class'DS. "�
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Remark:This test was subcontracted to SGS-CSTC Standards Technical Services Co., Ltd Xiamen Branch
Testing Center. ,,^�� ,\
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