HomeMy WebLinkAboutFAI18-0002 CALFIRE Suppresion Hood Inspection- 'et Cthemical•Pre-Engineered
Fire Extinguishing System
California Code of Regulations Title 19
Inspection, Testing, and Maintenance
Property Information
Building Name
lM(k-5 5 0•0
Address 4-04
t
tkvti•k(k
City "j�trlty2yv\c.
o
Contact Person
7Y 2-61 (90
Phone
of'L
1,.\ot1
hPi ( i ; Zv�
License #
462979
SFM
CSLB
Cylinder Size
System Location
Fuel/Heat Shut Off:
System Information
Last Hydrostatic Test Date 20
System Mfr. I��yIL
Semi -Annual
Report
1 oft
Contractor or Licensed Owner Information
Name
Wilgus Fire Control Inc.
Address
1703 Sonoma St.
City
Redding St. Ca. Zip 96001
Phone
503-241-2465
Job #
Misc.
Flow Points Capacity Used
Model # Q - W-1 3
Gas #
Electrical #
Integral Make Up Air Shut Down
items
Hoods
Plenums
Ducts
# of,ltems'
Appliance Nrxte'
(2—kiv4sq X 7'1
F
lozzle
etx4
-Nozzle
<FIow Points
Cooking Appliances
Left to R ht with Sizes and Coverage Nozzles
ozzI r T6'tai�
w PcfF}q+Ppihts" .. .
Flo iiia-
l_
Appliance Name
Nozzle - `
•
Qt
Nozzle
Model
Ei3it ts;
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity'
2
c)C
utfr'
ate;,
2-E i.1
ln�tali;a ;,
Date;
2-2- - f
Quantity
Temp
Mfr
Date
Je
Inspection, Testing, and Maintenance
Form AES 20
Sept. 3, 2013
a �C r = rass F = Fail N/A = Not Applicable
:Item
Description,,'
A
NEPA 17A C -
_ ed ;Reference_
Date
�� x
Comments Onlyr *,
{P P. A.
1.1
I
Manual Actuators are Unobstructed`
(i.e. Remote Pull Station)
7.2.2(2)
I Z'2. -i,
1.2
1
Tamper Indicators & Seals Intact
7.2 2(3)
j Z -Zs -i'1
1.3
I
Maintenance Tag in Place
7.2.2(4)
Title 19 §906
‘Z -Z-43. I
1 4
I
No Obvious Physical Damage
7.2.2(5)
12,.,2 -1.1
1.5
I
Gauge Readings within Proper Limits
(Stored Pressure)
7.2.2(6)
17.,-,,-F1
N I A-
1.6
I
Blow -Off Caps in Place & Undamaged
7 2 2(7)
1.7
I
Hoods, Ducts, Filters in Place and Clean
CFC 904.11.6.3
izii.8- I`F
(�
C
1.8
I
Hood, Ducts & Protected Cooking Appliances Have
Not Been Replaced, Modified or Relocated
72.2(8) Jz--
7 3.3.4
112
L
1 L, z_ -1
1
T
Automatic Detection/Manual Actuation Functioned
Correctly
Form AES 20
Sept. 3, 2013
FAI18-0002
031-172-082
Contractor or Licensed Owner Information
Name
Wilgus Fire Control Inc.
Job #
Wet Chemical Pre -Engineered
,Fire,Extinguishing System
California Code of Regulations - Title 19
Inspection, Testing, and Maintenance
Semi -Annual
Report
2 of 2
Property Information
Building Name Q\t oN-fix):`
Address LALA . >J
City •--F e _tV• L' \ ; * 0
D = Deficiency
Item
inspection, Testing, and Maintenance
I = Inspection T = Test M = Maintenance P = Pass F = Fail N/A = Not Applicable
:Item
C
gescti tiptt �;
UNFPA 1:VA0
iiil 13ef ten
Date,.'
ComrrlentsLO�r) t ) ° "•ivr1
tlA
2.2
T
T
Fuel Shut -Off Operated Correctly
Regulator Tested & is within Acceptable Limits
7.3.3.4
7 3 3 4
17„.24_10(
1'z: 1.'S-1"►
2.3
2.4
T
Manual Reset Relay Functioned Correctly
(If Applicable)
7.3.3.4n
12 Z�S 1"�
r
3.1
M
All Agent Containers within Acceptable Hydrostatic
Test Dates
7 5 1(1)
AZ,LS-1?
{�
�`t
3.2
M
All Auxiliary Pressure Containers and/or Hose
Assemblies within Acceptable Hydrostatic Test Dates
7.5.1(2)(3)
JZ' 2.5. I 1
eJ 1
3.3
M
Cartridge Weights within Acceptable Limits
7.3.3.1(2)
j z n.,1F.
3.4
M
Liquid Level within Acceptable Limits
(Non -pressurized)_
7.3.3.1(2)
I c.."Z�3 1`1
I hereby certify that the tire 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.
3.5
M
No Signs of Corrosion in Agent Cylinder
(Non -pressurized)
7.3 3.1(2)
jZ 7' 11
-_FDate t - 7,z3 — 1
P
3.6
M
Distribution Piping Unobstructed and Contiguous
7.3.3.1(3)
fj 2-Z5.1-1
3.7
M
Nozzles are Correct, Clean & Properly Aimed
Fixed Temp Fusible Metal Alloy Type Detectors Replaced
7.3.3.1(2)
7.3.4
' 2.-_1'lCF
12- 1-1
'\
�t ;IN
1
3.8
M
3.9
M
Fixed -Temp (Other Than Fusible Metal Alloy Type) &
Heat Detectors Maintained or Replaced
7.3.5
1
12'L'�"�
M
Auxiliary Equipment Such as Water valves
Functioned Correctly
7 3 3 1 2
()
JZ '��
v..1 tik
3.11
M
Internal Maintenance as Required by Manufacturer
Title 19 §904.7
iz.251`1
D = Deficiency
Item
C
Date
= Comment
Riser
_ _
(Indicate
D
,__ ,, - _
C
type)
Deficiencies and Comments
Indicate all equipment, devices and parts that were repaired or replaced
4
Il Check
here if additional Deficiencies and Comments are listed on Form AES 9. Number attached _
Form AES 10 for corrected deficiencies. Number attached.
10 See Correction
I hereby certify that the tire 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
.- -c-E-00-.,
u�t t -�
Signature
`'(kik
"
-
; `_
-7
-_FDate t - 7,z3 — 1
Form AES 20
Sept. 3, 2013
FAI18-0002
031-172-082