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INC. Invoice
WILGUS FTRE CONTROL
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SAFEGUARD FIRE PROTECTION
1 703 SONOMA ST. By-------- Date I Invoice# I
REDDING, CA 96001 L-----
6/13/2019 I 125865
•
Bill To Ship To
GOLDEN EMPIRE COUNCIL 21359 SCOUT RD
BOY SCOUTS OF AMERICA BUTTE MEADOWS
P.O. BOX 13558
SACRAMENTO,CA 95853-3558
IP.O. No. 1 Terms Rep
II NET 10 I REW
Qty S/W Part# Description Price Each Amount
1 Service call Service call 50.00 50.00
2 Xsery Extinguisher Service K-CLASS 11.00 22.00
12 Xsery Extinguisher Service 2.5# 11.00 132.00
21 Xsery Extinguisher Service 5# 11.00 231.00
1 Xsery Extinguisher Service 10# — 11.00 11.00
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Sales Tax (7,25%) Moo
Total V $446.00
1 Phone# II Fax# E-mail
i I Web Site
(530)241-2465 il (530 241-2473 safeguard@wilgusfire.com 11 www.wilgusfire.com
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WILGUS FIRE CONTROL INC. U \�� Invoice
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SAFEGUARD FIRE PROTECTION \II
]703 SONOMA ST, SUN 17 201g I Date I Invoice#
REDDING, CA 96001 6/13/2019 I 30628
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Bill To -L1--- Ship To
GOLDEN EMPIRE COUNCIL CAMP LASSEN
BOY SCOUTS OF AMERICA
P.O. BOX 13558
SACRAMENTO,CA 95853-3558
I P.O. No. I Terms I Rep
INET 10 I REW
Qty S/W Part# Description I Price Each Amount `
1 Ysery ANSUL R102 SEMI-ANNUAL SYSTEM SERVICE 135.00 135.00
6 439088 Fusible Link,360°F(SL Style)Red 12.00 72.00T
15 77,695 Rubber Blow Off Caps 5.00 75.00T
! 304 lq' 1
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\4,<,.._' *S_L_rEr „Stgc, , ., .
Sales Tax (7,25%) $10.66
Total X $292.66
Phone# (I Fax# II E-mail „ Web Site 1
1 (530)241-2465 1 (530 241-2473 II safeguard@wilgusfire.com J
www.wilgusfire.com I
I 1 14 1 11 i'h I. •, I II- a HI II III 11,I ' Id 'I Y 1 iuq I,E II I� Ill III "I'I III P u i I 111101 YiY II II
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Fire Extinguishing System Inspection,Testing,and Maintenance Report
Property Information Hof oa<<4.
�� �r � Contractor or Licensed Owner Information
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Building Name Cc.,,,,, �3'.�ii a Name Wilgus Fire Control Inc.
Address ( - Kell' . JIB s. Address 1703 Sonoma St.
P/R_ City Redding St. Ca. Zip 96001
City tc T/ c 4j..4s c , ,t- s License# 462979 Phone (530)241-2465
Contact Person ❑ SFM Job#
Phone ° °'7 3 Lf ol6. / ® CSLB Misc.
System Information
Cylinder Size • -rev_ (.� Last Hydrostatic Test Date ( - f 16 Flow Points Capacity Used ''Z_.. -
System Location kr i System Mfr. 7S-(.. ' Model# J _,
FueUHeat Shut Off: A,
Gas# A Electrical#r ! ' =
Integral Make Up Air Shut Down
Hoods k /`72 1 '`
Plenums Le,/
I ) I Ce I i «
Ducts I `) . I /7 i7 (.2k7 J Z.L(—) I . I I
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
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zt `..6 b Y im
At l .lip. Ai -- _ci- I i I
'./ e ear' I . I -- 14 I I
1'1 1 - I / II I I I I I I I I I
.rthrivii.A. I ) ' I f I t I I I . I I
0Il I " I I I I I . I I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
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f:=:,-.33f1,t41/3-1-3';;;;3.,_; 33-3----" .„—33, 373-,-;-- --;- ----- 3- ;:;;I:-,3,;135a3--------3---- 2;;;3 -!!''-',3-..--- ,10',-;i%-:,-- -.3„. 3 f
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- Inspection,Testing,and Maintenance
1 =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
1 1 i Manual Actuators are Unobstructed 7 2 2(2)
(i.e.Remote Pull Station) ,--_,...,--,- ;-,-----Awif:-., - , ---,-,--w,....t,:,,..h.!.1=',$‘ , =--. ,--_,-„,----_----, ,,,,....-7_
1.2 I I Tamper Indicators&Seals Intact 7.2.2(3) I I yr.
I 1.3 I I Maintenance Tag in Place 7.2.2(4) I I I
Title 19 6906 ie
I1.4 I I No Obvious Physical Damage _ 7.2;2(5) I I I I'"
1.5 I I Gauge Readings within Proper Limits 7 2 2 6 I t
(Stored Pressure) ( )
1.6 I I Blow-Off Caps in Place&Undamaged 7.2.2(7) I I I
1.7 I I Hoods,Ducts,Filters in Place and Clean CFC 904.11.6.3 I I I
ie
1 8 I I Hood,Ducts&Protected Cooking Appliances Have 7 2 2(6) I I
Not Been Replaced,Modified or Relocated
2.1 I T [Automatic Detection/Manual Actuation Functioned 7.3.3.4 I
Correctly
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Form AES 20
Sept.3,2013
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ii i , 1Niuii ;up_ Sufi W;ill a,,, i �Ynia �i '�i 1:�, t ,,'9t+ 1 eofil,l Iluioi_;mil Yu itii1
Fire Extinguishing System Inspection,Testing,and Maintenance Report 2 of 2
Property Information ,�% Contractor or Licensed Owner Information
;Al! (Ir I *et 9 rl
Building Name �' ;y Name Wilgus Fire Control Inc.
Address . _/ -3 Ca se, f i 1,- \ .., Job#
City 15 e-f v rII/ ,. .t a„ ra �'+��,4e M � +
Inspection,Testing,and Maintenance 1
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
2.2 T 'Fuel Shut-Off Operated Correctly 7.3.3.4 I
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 I I
2 4 T (Manual Reset Relay Functioned Correctly 7.3.3.4 I I`V
1 of Applicable)
3.1 M rII Agent Containers within Acceptable Hydrostatic 7 51(1)
Test Dates
II Auxiliary Pressure Containers and/or Hose I I /- '
3.2 M 7.5.1(2)(3) 1✓semblies within Acceotable Hydrostatic Test Dates
3.3 M 'Cartridge Weights within Acceptable Limits 7.3.3.1(2) I I ''
3.4 M I Non-o ssurizedin Acceptable Limits 7.3.3.1(2) I 1/61
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2)
I '
(Non-pressurized)
3.6 M 'Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) I I i
3.7 M 'Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) I I
3.8 M 'Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 I I
3.9 M IHeatDetectors Maintained oriReolacedOther Than Fusble MetalAlioy Type)& 7.3.5 I I TM
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3.10 M ary qpent Suc asWater valves 7.3.3.1(2) t
FunctuxiliionedE Correctlyuim h
I 1761/"
3.11 M 'Internal Maintenance as Required by Manufacturer Title 19§904.7 I I r1)<A,
1 D=Deficiency C=Comment (indicate type) I
Item Date Riser D C l e rcrenctes an. ommen s
Indreate all equipment,crevices and pacts that were repaaired or reptace'J „_
I I
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1
II
1
❑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.
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Print Name I tl ii l , v L J i t, -e
Signature I ;
ir Date /3 —
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Form AES 20 Sept.3,2013