HomeMy WebLinkAboutFAI19-0018 Suppression Hood Inspection 2019 Wet Chemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual 1 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
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Property Information � Contractor or Licensed Owner Information
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Building Name1/40_,,(5,-;J7---
�„` Vc -�ekM �l Q, D Name Wilgus Fire Control Inc.
Address 7�& �'roo�44-1i yfi-v� : J v Address 1703 Sonoma St.
,ARE i' City Redding St. Ca. Zip 96001
City(Pry e-L)Z .e License# 462979 Phone (530)241-2465
Contact Person ,00,412 ❑ SFM Job#
Phone 5-"T? � - .z., 3-tC� ji_c ® CSLB Misc.
` System Information
Cylinder Size 1 OW Last Hydrostatic Test Date O 7 Flow Points Capacity Used
System Location /(,-1 ck.--c System Mfr.A 4./.266L. Model# lid--
Fuel/Heat Shut Off: )C
Gas#()( Electrical# Integral Make Up Air Shut Down
Items #of Items Dimensions Nozzle Nozzle Nozzle Total
Model# Flow Points Qty Flow Points
Hoods ( Y 2(- (Z Ai
Plenums (/v ( 2,
Ducts / bill( 9 2-al 2-, ( "Z—
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Nozzle Nozzle Total Nozzle Nozzle Total
Appliance Name Model Flow Points Flow Points Appliance Name Model Flow Points Flow Points
r. 7, ,:id G�( 1 iv )
G 3rA,-i--c"- f l' l
6-",'01/1-c l ltl 1
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Mfr Install Mfr Install
Quantity Temp Date Date Quantity Temp Date Date
Inspection,Testing,and Maintenance
=Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
NFItem Description Date Comments Only P,F,NIA
ed.R
ed.ReferferA CAence
Manual Actuators are Unobstructed
1.1 I (i.e.Remote Pull Station) 7.2.2(2)
1.2 I Tamper Indicators&Seals Intact 7.2.2(3) /52
1.3 I Maintenance Tag in Place 7.2.2(4)
/2
Title 19§906
1.4 I No Obvious Physical Damage 7.2.2(5) jt
1.5 I Gauge Readings within Proper Limits 7 2 2(6) /f�
(Stored Pressure) /"
1.6 I Blow-Off Caps in Place&Undamaged 7.2.2(7) P
1.7 I Hoods,Ducts,Filters in Place and Clean CFC 904.11.6.3 }�
Hood,Ducts&Protected Cooking Appliances Have ,Q
1.8 I Not Been Replaced, Modified or Relocated 7.2.2(8)
/j
2.1 T Automatic Detection/Manual Actuation Functioned 7.3.3.4
Correctly
Form AES 20 Sept.3,2013
Wet Chemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual 2 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
ti
Property Information AA.
s/\e r Contractor or Licensed Owner Information
/y% `I-ii 1l)
Building Name(() j1, h=�� v(,\ / i Name Wilgus Fire Control Inc.
Address `iiilteFar�Tfy<t// l/J�i/y� I r0 3,,, , .4% Job#
A7/3E tilg's-f
City 0/7,Cats
Inspection,Testing,and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
.NFPA 17A CA
Item Description Date Comments Only P,F,N/A.
ed.Reference
2.2 T Fuel Shut-Off Operated Correctly 7.3.3.4 U
2.3 T Regulator Tested&is within Acceptable Limits . 7.3.3.4 4
2 4 T Manual Reset Relay Functioned Correctly 7.3.3.4 /11/4
(If Applicable) A
3.1 M All Agent Containers within Acceptable Hydrostatic 7,5.1(1)
Test Dates
3.2 M All Auxiliary Pressure Containers and/or Hose 7.5.1(2)(3)
Assemblies within Acceptable Hydrostatic Test Dates I)
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2) p
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2)
(Non-pressurized) IP
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2)
(Non-pressurized)
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) te
3.7 M Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) p
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4
Fixed-Temp(Other Than Fusible Metal Alloy Type)& �`jf
3.9 M HeatDetectorsMaintained or Replaced 7.3.5 /�
3.10 M Auxiliary Equipment Such as Water valves 7.3.3.1(2) 1/7-
Functioned Correctly /1-
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904.7 ,�/��
D=Deficiency C=Comment (Indicate type) (!'
Item Date Riser A C . Deficiencies and Comments
Indicate all equipment,devices and parts that were repaired or replaced
❑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.
Print Name g,:Gs-a.r 0 Li f 0 "
Signature 07Date
,,LZ,...
Form AES 20 Sept.3,2013