HomeMy WebLinkAboutFAI18-0001 Fire Annual Inspection Suppression Hood Inspectioni,.,
Wet;Cltemtca) Pre -Engineered California Code of Regulations - Title 19
,Fire Extinguishing System Ins • ction, Testing, and Maintenance
`Prroperty Information'Th;20
Building Name Q 4tr A L.. C":>a't)L ,
Address
rot
43,
4
Semi -Annual
Report
1 of 2
Contractor or Licensed Owner Information
Name Wilgus Fire Control Inc.
Address 1703 Sonoma St
City Redding St. Ca. Zip 96001
City itkt_vNe.��'FC
Contact Person ---5 Ci L iL
Phone — 3 1 (,' Z)
License #
462979
SFM
j CSLB
Phone
503-241-2465
Job #
Misc.
Cylinder Size � Last Hydrostatic Test Date -Z O (1c� Flow Points Capacity Used
CCL
System Location ICk iSystem Mfr. ..& k...S,j l u... Model # e_- W i - 3
LL
Fuei/Heat Shut Offs
Gas # t j Electrical # ✓ Integral Make Up Air Shut Down
Items
# of Items
.� :_
Di in.; as
! ,. y w° : 1�.
Nozzle
; --6044t-.,
Nozzle
RIOsO rots:
Nozzle
Qty' ..
%tat
`' 1e vcPfiihts ,
Hoods
Manual Actuators are Unobstructed
(i. e. Remote Pull Station_)
t
X
�"' 17
t.
k
1.2
Plenums
Tamper Indicators & Seals Intact
tL
i '
P
1.3
Ducts
1
' K'-' 3 it
i In) -
1
1.4
Left to Right
Cooking Appliances
with Sizes and Coverage Nozzles
7.2.2(5)
Appliance N r e' -,
` Nozzles ;
` M6rfet�
tie - e '
.,
Flovl'bir5ts
r I stal
Appliance'Name
�Ibwoints
:Nozzle.`
. Model `
..Ndz
Floln tkiit"
'� , tal<-.:
1 oNii:41oiftts
a.A.' Lk Y 2 S
•Z i -t 'c
2-
`7
I
-
7.2.2(7)
i z8. 11
1.7
1
Hoods, Ducts, Filters in Place and Clean
CFC 904.11.6.3
jz.Z.S -17
1.8
I
Hood, Ducts & Protected Cooking Appliances Have
Not Been ReplacedLModified or Relocated
Automatic Detection/Manual Actuation Functioned
Correctly
7.2.2(6)
7.3.3.4
la Z5-17
il - 17
2 1
T
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity
Temp
Mfr..: ;I6Stall
Date
tate Quantity
Temp
Mfr
Date =;
�, ift8 a
DateT.
'7--
y -e5 b
'7-0 i —7
24-1—
Form AES 20
Sept. 3, 2013
Inspection, Testing, and Maintenance
= Inspection T= Test M = Maintenance P = Pass F = Fail N/A = Not A, plicable
iPAN/A;.
..Item ..
`_
Descnption.
NEPA 17A':CA.
edReference:'
Date
a
Comments O, n .� y
1 1
I
Manual Actuators are Unobstructed
(i. e. Remote Pull Station_)
7 2 2(2)
�"' 17
1.2
1
Tamper Indicators & Seals Intact
7 2 2(3)
' z•ZSf.)i
P
1.3
1
Maintenance Tag in Place
7.2.2(4)
Title 19 §906
(Z -ZS- 11
1.4
I
No Obvious Physical Damage
7.2.2(5)
1
(. . ZS -0
1.5
I
Gauge Readings within Proper Limits
(Stored Pressure)
7 2 2(6)
I Z 2-l�
v...1\ pi
1.6
I
Blow -Off Caps in Place & Undamaged
7.2.2(7)
i z8. 11
1.7
1
Hoods, Ducts, Filters in Place and Clean
CFC 904.11.6.3
jz.Z.S -17
1.8
I
Hood, Ducts & Protected Cooking Appliances Have
Not Been ReplacedLModified or Relocated
Automatic Detection/Manual Actuation Functioned
Correctly
7.2.2(6)
7.3.3.4
la Z5-17
il - 17
2 1
T
Form AES 20
Sept. 3, 2013
FAI18-0001
031-020-023
Wet ChemOcai Pre -Engineered
Fire Extinguishing System
California Code of Regulations - Title 19
Inspection, Testing, and Maintenance
Property Information
Address 'Z .Zy+; • I! -
Semi -Annual
Report
2 of 2
Contractor or Licensed Owner information
inspection, Testing, and Maintenance
I = Inspection T = Test M = Maintenance
P = Pass F = Fail N/A = Not Applicable
= Comment
Riser _
- ,
Item'.
Indicate
C
_„_,
fl0....'rt tion k '
NEPA 17{LC�1
.ed ite etente'
7.3.3.4
-''1?-*!.
jz ZS. -1/1
Comments Ong
cl�fA
`
2.2
T
Fuel Shut -Off Operated Correctly
2.3
T
Regulator Tested & is within Acceptable Limits
7.3.3 4
7.3.3.4
lis_ v5,11
17_--1.7
c:"
2.4
T
Manual Reset Relay Functioned Correctly
(If Applicable)
3.1
M
All Agent Containers within Acceptable Hydrostatic
Test Dates
7 5 1(1)
1L 1-I
3.2
M
All Auxiliary Pressure Containers and/or Hose
Assemblies within Acceptable Hydrostatic Test Dates
7.5.1(2)(3)
2-Z;j- j
��
3.3
M
Cartridge Weights within Acceptable Limits
7.3.3.1(2)
1•Z Zg- j')
P
3.4
M
Liquid Level within Acceptable Limits
(Non-pressurizedy
7.3.3.1(2)
Z -i1
3.5
M
No Signs of Corrosion in Agent Cylinder
(Non -pressurized)
7.3 3.1(2)
; z._2.,-,
Print Name
l
3.6
M
Distribution Piping Unobstructed and Contiguous
7.3.3.1(3)
1. j-4-1
3.7
M
Nozzles are Correct, Clean & Properly Aimed
7.3 3.1(2)
(Z-2 -F1
3.8
M
Fixed Temp Fusible Metal Alloy Type Detectors Replaced
7.3.4
j'2:1-51/
3.9
M
Fixed -Temp (Other Than Fusible Metal Alloy Type) &
Heat Detectors Maintained or Replaced
7 3 5
12-7-5-11
P
3.10
M
Auxiliary Equipment Such as Water valves
Functioned Correctly
7 3 3 1(2)
mar,
3.11
M
Internal Maintenance as Required by Manufacturer
Title 19 §904.7
(1-2 5-11
Name
Wilgus Fire Control Inc.
Job #
D = Deficiency
Item
. t ..
C
Date
.. ;,;,_.�,,,.4„+_
= Comment
Riser _
- ,
. D
,-•_„ _
Indicate
C
_„_,
type )
Deficiencies and Comments
Indicate EV/equipment devices and parts that were repaired or replaced
• Check
here if additional Deficiencies and Comments are listed on Form AES 9. Number attached
Correction Form AES 10 for corrected deficiencies. Number attached:
• See
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
l
kA.L \\ (7______
Date 12 - 2 - 1
Signature
Form AES 20
Sept. 3, 2013
FAI18-0001
031-020-023