HomeMy WebLinkAboutFAI17-0005 CF Suppression Hood Inspection 2018Wet Chemical Pre -Engineered
Fire Extinguishing System.
Property Information
California Code of Regulations - Title 19
Inspection, Testing, and Maintenance
A
Building NameCAN.vv‘ f� 0 � Zkik
-
Address -l'-{ sC� tti }�
—y\ \tom 0 -el 0 UA 2- l
Contact Person G
Phone lc; - iqta"
City
i
•
J i
Semi -Annual
Report
1 oft
Contractor or Licensed Owner Information
Name
Wilgus Fire Control Inc.
Address
1703 Sonoma St.
License # 462979
SFM
CSLB
Cylinder Size '3 tjalto )(
System Location 0v‘,
City
Redding Oa Zip 96001
Phone
530-241-2465
Job #
Misc.
System Information
c l Last Hydrostatic Test Date Z0 ► Z_
Flow Points Capacity Used 3
Fuel/Heat Shut Off
Gas #
System Mfr. pc-
Model # - lD i. -- 3
Electrical #
Integral Make Up Air Shut Down
terns"-'
Hoods
Plenums
Ducts
bR1tet ;ls
M
imentiort5-' ,=
Nozzle -
i'3}c4`Li
<V 77 X `r !-�
I-3'xl'{•3-241 t N
Cooking Appliances
Left to Rt9ht with Sizes and Coverage Nozzles
„10,4FioW Points
Appliance Name;:
ozzle
A6dei
Nozzle
Flow 1 Pints
.Nozzle
Flo4V Points
Appliance. Name
Nozzle
Model
Ni
Points
W c. tom, '-{
z4
Z�4
?, to O
X15
Z
2-
1
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity
Ternp
Mfr
Date
InstaU
Date
Quantity
Temp
Mfr
Date
Install
Date:..
L-1 so
Cl
Form AES 20
Sept. 3, 2013
Inspection, Testing,'arid Maintenance
= Inspection T = Test M = Maintenance P =
Pass F = Fail` N/A = Not Applicable
Item
Description'. `"
NFPA 17A CA .
ed: sReference.
Date
Comments Only
P;F;N!A.
1.1
I
Manual Actuators are Unobstructed
(i.e. Remote Pull Station)
7 2 22
( )
tic
1.2
I
Tamper Indicators & Seals Intact
7.2.2(3)
_b.._
t _II_tg`F
1.3
1
Maintenance Tag in Place
7.2.2(4)
Title 19 §906
G•-4"i�
n
P
1.4
1
No Obvious Physical Damage
7.2.2(5)
&- [,.{. t
1.5
I
Gauge Readings within Proper Limits
(Stored Pressure)
7 2 2(6)
(9�� • t
��
1.6
I
Blow -Off Caps in Place & Undamaged
7.2.2(7)
- „4.18-
e
1.7
I
Hoods, Ducts, Filters in Place and Clean
CFC 904.11.6.3
V� 1„ .- i-+ ,(e
1.8
I
Hood, Ducts & Protected Cooking Appliances Have
Been Replaced, Modified or Relocated
7.2 2(8)
(Q ` - i
c4)Not
2.1
T
Automatic Detection/Manual Actuation Functioned
Correctly
7 3.3.4
�i �` r
Form AES 20
Sept. 3, 2013
Wet Chemical Pre -Engineered California Code of Regulations - Title 19
Fire Extinguishing System Inspection, Testing, and Maintenance
of CA kk
'/'c ' I \ (
Vj l—i
Semi-Annua
Report
2 of 2
Property Information
Building Name Cc—yn O ke%t
Address 4 Z; -
City `E.u..,l'-.'-N CAL L.O._
a\
�'hRE IAN
Contractor or Licensed Owner Information
Name
Wilgus Fire Control Inc.
Job #
Inspection; Testing,
and Maintenance
P = Pass F = Fail N/A = Not Applicable
= Inspection T = Test M = Maintenance
Item
f Riser
,,.r pas a o
N PA�Z�
F Date
Comments b ' 1
N/A:'
2.2
T
Fuel Shut -Off Operated Correctly
7.3.3.4
L - 4_M
.
2.3
T
Regulator Tested & is within Acceptable Limits
7.3.3.4
f-., y- i
S
2.4
T
Manual Reset Relay Functioned Correctly
(If Applicable)
7.3.3.4
ys"+
ty _ 4• is
3.1
M
All Agent Containers within Acceptable Hydrostatic
Test Dates
7.5.1 1O
�_ (�
3.2
M
All Auxiliary Pressure Containers and/or Hose
Assemblies within Acceptable Hydrostatic Test Dates
75.1(2)(3)
I„' 4.. cis
i
3.3
M
Cartridge Weights within Acceptable Limits
7.3.3.1(2)
(3 -y-lt
3.4
M
Liquid Level within Acceptable Limits
(Non -pressurized)
7. 3. . 2
13O
L' tet' IT
O k k
3.5
M
No Signs of Corrosion in Agent Cylinder
(Non -pressurized)
7.3.3.1(2)
6 - ii' IT
Print Name --��
t. ( --
3.6
M
Distribution Piping Unobstructed and Contiguous
7.3.3.1(3)
i9 _41_ r
1
,Q
`:)
3.7
M
Nozzles are Correct, Clean & Properly Aimed
7.3.3.1(2)
co _t{._) 0
3.8
M
Fixed Temp Fusible Metal Alloy Type Detectors Replaced
7.3.4
U-4_ Ig
-#/1`
3.9
M
Fixed -Temp (Other Than Fusible Metal Alloy Type) &
Heat Detectors Maintained or Replaced
7.3.5
G- 4 -146
0 i IL
1 �
3.10
M
Auxiliary Equipment Such as Water valves
Functioned Correctlyly
7.3.3.1(2)
1„_ - f
t� j
►J Pt -
3.11
M
Internal Maintenance as Required by Manufacturer
Title 19 §904.7
(. if -16
D = Deficiency C = Comment
Indicate type)
item
gate
f Riser
D
C
, d
Deficiencies and Comments
. _ _ _ , Indicate all equrprnent devices and parts that were repaired or replaced
ir• 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:
1 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 --��
t. ( --
Signature.
l
�- '-----� Date es - Ll • I ��
Form AES 20
Sept. 3, 2013