HomeMy WebLinkAboutFAI17-0001 CF Sprinkler Test 2020 ,-.
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Property Information ...=''', ,-''- '. Asely, Contractor or Licensed Owner Informati.-in
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!Building Name , /
Wilgus Fire Control Inc
'40. • ak e . /.., 7- ft ' 't. (j):‘.cell I, , i!) Name
!Address 9 5-, Artw,„.; v.7,::, 076' •.>.`ie-, Address 1703 Sonoma St
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CilL14 v,61044,... _ IL-cense# 462979 IPtione (530)241-2465
Contact Person if/iti
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Cylinder Size I . , . Last Hydrostatic Test Date / .5 Flow Points Capacity Used -7 i
!System Location/ 74 System Mfr. Eiji/5/ft: - Model# ./(0/0-,.?
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IFuel/Heat Shut OffA
IGas# (I<
Electrical'At
Integral Make Up Air Shut Down
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.0',. , . Model#';•.. ,: Flow'Points' •-•`':' --',- -`Qty:',- - Flow Po
Hoods I I 0. 4./.1- , I 1
IPlenums L 1
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'Ducts I / I -----L- /
Cooking Appliances
Left to li.c1ht with Sizes and Coverage Nozzles
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!'"4".ilf,V-' Flow Points 'Flow Points ''Pimance Name :171:1' 'I'HOW Peints Flow Points,
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Fixed Temperature Sensing Elements
• (Such as Fusible Links)
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Install •-.1
i Quantl*/ Temp Date I Date • • t A f r , I Quantity Temp . Date
Date , 1
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I = Inspection T = Test M = Maintenance ,''' = ,---',It.L r: - - ,.. 4 =
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Date
CommentsII P F N/A I
-i -,--- -,',-'''-'71't.:".%11'.`TZ'''''•.:' •,!:-•...''- ,".. , ••' ' ed.Reference Only . $_11 I 1 !Manual Actuators are Unobstructec
I ii.e Remote Pull Station1 -L.2.:-, 1 l
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12 I I !Tamper Indicators& Seals Intact ' - 2 213)
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1.3 I 'Maintenance Tag in Place
Title 19 -;906 40` _.]
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1 4 liNo Obvious Physical Damage :2if,i -7
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Gauge Readings within Proper Limits
7 2 i',61
A/(41
(Stored Pressure
1 6 I Eilow-Off.Caps in Place&Undamaged -2 217i
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1 7 I Floods.Ducts. Filters in Place and Clean CFC 904 11 6 3
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iood.Ducts S Protected Cooking Appliances Have
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7.2.2(81
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Not Been Replaced.Modified or Relocated
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2 1 I T lAutomatic Detection/Manual Actuation Functioned
7 1 3 4 I P 11
'Correctly
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`orm AES 20
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Property Information etc,• o Contractor or Licensed Owner Information
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, 1� 1�yGcs % 3 , Name Wilgus Fire Contro Inc
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' `n T =Test M = 't: r. - - ' '-as5 F= = \toy 4opt'cab;g
NFPAI7ACA
,-„ .. ., -- -„ Date I . Comments OnlyP,F,N/A,
Ito � .K . ;. ed.Reference
' ' Z T Fuel Shut-Off Operated Correctly ' 3.3 4 [ 11
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Reguiaty Tested&is within Acceptable Limits 7 3.3 4 At I
Manual Reset Relay Functioned Correctly 7 3 3 4 Y.k 1
kitt DMILeeiei — - -- -- — — .. _
z 1 t, AI!Agent Containers within Acceptable Hydrostatic I 7:5 i(1) I
'Test Dates
Ali Auxiliary Pressure Containers and/or Hose 1
3 Z M I -5 1(201
Assemblies within Acceptable Hydrostatic Test Dates
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t: IC i`tr c;;e',3eights within Acceptable Limits f 2 3 1;1? , , 0
`Level within Acceotable limits I 3.1(2)
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tNc ?•pressurized;��,,, No Signs of Corrosion in Agent Cylinder ,3,3 1(2) �
i N on-pressurized) —_ —
_ . , .• _ :=c =spits Unobstructed and ContigJous 3`
._ __.;Y. _ N. �,zules are 0 rest Clean& Prcaeriy A:rrea ..—�r.� 3 -Z -- _..__. ,.
_,,_ ' Ye-'e s usible Metal AlioV T'yae Detectors Replaced _ 3 4— _—, _ fr
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to IF xrei-Tema iOther Than Fusible Metal Alloy Tvpei B I qr//�
�hea:Detectors Maintained or Replaced • .3 /r`/
.� IAux•i;ary Equipment Such as Water valves I 7 33 1(2) I
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F_nctioned Correctly
' '• M Internal Maintenance as Required by Manufacturer ( Title 19`;904.7 I I It/4
._____ell } Comment (indicate type? — Y
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'rta,,.•s{..... 't,1c:i.3nal Deficiencies and comments are listed cr+Form AES m e`atta.'teo
,_... -orm AES 10 tot corrected deficiencies Number attacned
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 Na`T`t'
ignat:.;te Date 6d> �'�216-1
Z Sent 3 2013