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Form CMS-2786R 06/07 EF 06/2007 Page 1 Name of Facility ID PREFIX MET NOT MET N/A REMARKS PART I - LSC REQUIREMENTS - Items in italics relate to the FSES BUILDING CONSTRUCTION K11 If the building has a common wall with a nonconforming building the common wall is a fire barrier having at least a two hour fire resistance rating constructed of materials as required for the addition. Communicating openings occur only in corridors and shall be protect.

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