HomeMy WebLinkAboutFAI17-0005 CALFIRE OVERHEAD SPRINKLER HYDRO TEST met Chemical Pre-Engineered California Code of Regulations-Title 19 ' Semi-Annual
Fire Extinguishing System Inspection,Testing,and Maintenance Report 1 of 2
Property Information ;��c F_CA.c4c'pil Contractor or Licensed Owner Information
Building Name F�i�Vh tJ C�k "�i� )> —
f Name Wilgus Fire Control Inc.
K �� a Address
Address y S 2_.( y . b
�--q/� t� r ���.. __-� 1703 Sonoma St.
L-11r� , 1 \SreC `0I.\Ia-k)' 0 �AEMP
City �� � � License462979 Phone Redding St Ca. Zip 96001_
Contact Person p_c 503-241-2465
❑ SFM Job#
Phone (c CSLB Misc -
System Information
Cylinder Size c Q, X Last Hydrostatic Test Date
System Location � �•�"�`,1� � �'LfJ\ � Flow Points Capacity Used .!3�
4'.0 System Mfr. PvjUL Model# e,... \ �- '
Fuel/Heat Shut Off rC
Gas# \ 'I 4" Electrical#
Integral Make Up Air Shut Down L �f)
Items #of Items Dimensions Nozzle Nozzle, t Nozzle '''otal
,, Model# Flew Points Qty . , 0*1?e(hts, ,
Hoods 4-1 Src r /
Plenums Li /'- 1--)(14 3..'!�K t r NA 1 d
Ducts Li V. VI 3 Y LI' (t 1 —
CI
Cooking Appliances e —
Left to Right with Sizes and Coverage Nozzles
•Appliance Name Nozzle Nozzle Total
Model Flow'Points Flow Points Appliance Name Nozzle' t �Niyz7~ s til
..f:r .,c:kQ,(t.._L} k Z `2 44 5 1-- / �� Model €F16 EI�r Jb�N,'Qihts
tv v..-A&a,\Q- 7i .i 0 - (.rte �� +��
1.4
l3.6 1
1A Z " \ N `
Fixed Temperature Sensing Elements —
(Such as Fusible Links)
Mfr Install
Quanti Temp
p Date Date Quantity Temp Mfrx°+� �.7t 1
�,,i 3 2 17 Date 1: r�
- J
inspection, Testing,and Maintenance
I = Inspection T =Test M=Maintenance
P=Pass F=Fail N/A =Not Applicable
_
Item Description NEPA 17A'CA
ed.Reference Date Comments Only ' ap F+N/A.
1 1 I Manual Actuators are Unobstructed ,
(i.e Remote Pull Station) 7 2 2(2) i 7_,12,.11 ,
1.2 I Tamper Indicators&Seals Intact 1
7.22(3) 12-i•Z'1'1 ��
1.3 I Maintenance Tag in Place
Title 19 006 2--l'liir) ()
1.4 No Obvious Physical Damage 7 2 2(5)
1 5 Gauge Readings within Proper Limits L' "Z 11 [�
(Stored Pressure) 7 2 2(6) t a-rz--VI \N
1.6 III Blow-Off Caps in Place& Undamaged _
7.2.2(7) it,\Z-1"1 -
1.7 III1Hoods, Ducts, Filters in Place and Clean
CFC 904 11.6 3 V2,12.-11
(57—
1 8III Hood, Ducts& Protected Cooking Appliances Have
Not Been Re.laced Modified or Relocated 7.2.2(8)
Z- 2'11
2 1 T •utomatic Detection/Manual Actuation Functioned
Correctly 7.3.3.4 12--I2-17 -^
Form AES 20
Sept. 3,2013
Wet Chem Cal Pre-Engineered` "California Code of'Regulations-Title 19 Semi-Annual 2 of 2
,,°,Fire.Extinguishing System • Inspection,Testing,and maintenance Report
Property Information f`POof Contractor or Licensed Owner Information
J ITh
Building Name " Vim` KN'7J - ( C 1D Name Wilgus Fire Control Inc.
Address y'LkG'j � 1 n 1. e_b ti\.�.. -.--.-- Job# 1
City q �+ �" �(Z—
.,t . �i.Mp�
—
Inspection,Testing,and Maintenance
1 =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
°NEPA 17AC,A
tterr t''escapf(on� .'bate Comments O I1a1
-' <Y ,�. _ . ... .L ed IRef�tence, .. . .,� ,. , t!�,Y��rt,6�.=' �� ��1/A
2.2 T Fuel Shut-Off Operated Correctly 7.3.3.4 12,-‘2,0
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 12.-12't+l
2.4 T Manual Reset Relay Functioned Correctly 7 3.3.4
(If Applicable) (l i ‘.....A
3.1 M All Agent Containers within Acceptable Hydrostatic ^
Test Dates 7.5 1(1) 12,12, �1 (��
3.2 M Al!Auxiliary Pressure Containers and/or Hose l
Assemblies within Acceptable Hydrostatic Test Dates 7.5.1(2)(3) 1,1Z-11
3.3 M Cartridge Weights within Acceptable Limits 7,3.3.1(2) ,2,_I.2+11 47
3.4 M Liquid Level within Acceptable Limits
(Non-pressurized) 7.3.3.1(2) tz+i, (-,
3.5 M No Signs of Corrosion in Agent Cylinder
(Non-pressurized) 7.33.1(2) 12-12-1'1
3.6 M Distribution Piping Unobstructed and Contiguous 7 3.3.1(3) i 2-i 2,-11
3.7 M Nozzles are Correct, Clean&Properly Aimed 7 3.3.1(2) j,Zvi,-I-,
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 1
i2.-ti-i1
3.9 M Fixed-Temp(Other Than Fusible Metal Alloy Type)&
Heat Detectors Maintained or Replaced 7.3.5 IS-It-11 Li
3.10 M Auxiliary Equipment Such as Water valves
Functioned Correctly 7.3.3.1(2) 1Z•vL 11 0\
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904.7 `1.-12+0
D=Deficiency C=Comment (Indicate type)
Item: Date Riser £ D C Deficienciesand Comments
,� ' „'_. ,' �-
a.„ . ,, -. Indicate all equipment,devices and parts that were repaired or replaced
❑Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached
❑ See Correction Form AES 10 for corrected deficiencies. Number attached
I hereby certify that the fire protection equipment listed above has been fully inspected, tested,and maintained on this date by
the company indicated above,in accordance with CCR, Title 19, Sections 901 to 906 and that the equipment is fully operable
except as noted in the"Deficiencies and Comments"section of this form.
Print Name
Signature 1 `si,-.-V"
Datet 2_ 1Z - % 1
Form AES 20
Sept.3,2013
FAJ 17-0005
062-240-008