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Wet Chemical ire-Engineered California Code of Regulations-Title 19 Semi-Annual
Fire Extinguishing System Inspection,Testing,and Maintenance 1 of 2
_ Report
Property Information �A�iF 1
n ����%y a oA Contractor or Licensed Owner Information
(Building Name, �L�� �P��4 �i/ � 11
`"r z S n Name
Address t � Wilgus Fire Control Inc.
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/ ',au i4 � 1,..,;;,„, _1,--___.- � Address 1703 Sonoma St
/ tE Mf* 'I
City Redding St. Ca Zip 96001
License# 462979 Phone 530-241-2465
'Contact Person /<'w 4 0 SFM
'Phone Job#
CZI CSLB Misc.
, System inforntatior
Cylinder Size
Last Hydrostatic Test Date (-3Flow Points Cyapacity Used
'System Location /.(,j'CLh System Mfr. , AY541
/
IFuei/Heat Shut Off: Model# A/(U 1_
(Gas# ,)4s. Electrical#
Integral Make Up Air Shut Down
Items #of Items hire sr� i� l�Iz � ., eN 1� 1� N ; to
Hoods I 1 ;in" , let '�� fttbld is ��� , , ��
/ I kit) r i7< I t is ;
Plenums /
'Ducts / 1 `I<
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name I Nozzle N+ I4TtSi � � �g _
m del ',IFidwipdiits pdrepairit _ , lta-,, a Nth' e Trat,- .
�i.6rctrK�c I i , i ` Ibui/i t31f1ts
II 1
II
IIII
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity Temp , , tr t tl - - -
mft
tei
�3Gt`� �Ste �1.,-
�$ � N�usntity I � Tetti�i�� �,��,��fr���: �������ettel
I i r II 1 ..�� ate
I I I II + I
Inspection, Testing,and Maintenance
=Inspection T Test M=Maintenance
I Item I I P Pass F Fail N/A Not Applicable
� DesCriptipn € � � � � � ,NFpA 1lA CA ,-�� P
ed l of re. ` bate; s �, Cbrttmehtso(1I �� ;
Manual Actuators are Unobstructed „� ,F,N/A'1
i (i.e. Remote Pull Station) 7.2.2(2) 9
I1.2 I I !Tamper Indicators&Seals Intact I
I7.2.2(3)
1.3 I Maintenance Tag in Place 7.2.2(4) ✓
I1.4 I I 1No Obvious Physical Damage Title 19 5)
t I
906 ,(>
I7.2,2( �
1.5 I Gauge Readings within Proper Limits
(Stored Pressure) 7.2.2(6) /,,' L I
I1.6 r I IBlow-Off Caps in Place&Undamaged
7.2.2(7) f I
I 1.7 I I 'Hoods, Ducts, Filters in Place and Clean
CFC 904.11.6.3 I
1 8I
I Hood, Ducts&Protected Cooking Appliances Have
Not Been Replaced, Modified or Relocated 7.2.2(8) I
I 2.1 T utomatic Detection/Manual Actuation Functioned
Correctly 7.3.3.4 r
Y1
Form AES 20
Sept.3,2013
Net Chemical Ire-Engineered California Code of Regulations-Title 19 Semi-Annual 2 of 2
p
Fire Extinguishing System Inspection,Testing,and Maintenance Report
'
/ f,C./1;N Contractor or Licensed Owner Information
Property Information „t'.- ,O
y1 '. " A fD Name Wilgus Fire Control Inc.
'Building Name///,./1//'/, i/i���/� t( ,.`� u� �, • /� i
'Address ^ ,4>--1/ idC"A* �/Cia. J-/i,Qt_ 9 ,,,� -y�Q Job#
1City Va.e-fie,km
7 ' ' inspection,Testing,and Nlaintenatloe I
=Inspection T -Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
- 1Y, * P,F,NIA:
Item Description F�� I 1 �._�., � -b
.. 0.
2.2 T 'Fuel Shut-Off Operated Correctly 7.3.3.4 I I I QP
2.3 T 'Regulator Tested&is within Acceptable Limits 7.3.3.4 I I I/IJ 4 i
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4 I l✓fj4-
(If Applicable) I I 1
3.1 M !All Agent Containers within Acceptable Hydrostatic 7 5 1(1) I
Test Dates
3.2 M IAiI Auxiliary Pressure Containers and/or Hose 7.5.1(2)(3) I I I/1//4
ssembiies within Acceptable Hydrostatic Test Dates I
3.3 M 'Cartridge Weights within Acceptable Limits 7.3.3.1(2) I I
3.4 I M ILiquid Level within Acceptable Limits 7.3.3.1(2) I I ( ,?-
(Non-pressurized) I I I /`
3.5 I M INo 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 y
I I
3.7 M 'Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) 0 ,
3.8 M 'Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7,3,4 I I If)
3.9 I M 'FHeatixed TempDetectors(OtherMaintain Thaned FusibleorReplaced Metal Alloy Type)& 7 3 5 I I ( /4/4
3.10 M Auxiliary Equipment Such as Water valves 7.3.3.1(2) I ( (t i f/d
(Functioned Correctly /�
3.11 M 'Internal Maintenance as Required by Manufacturer Title 19§904.7 I ' I Jf/d
D=Deficiency C=Comment (Indicate type) I
•
d Rtt
be*e ettees n. et h)ehts ,
Indicate all equipment devices and pads that Crete) paired or replaced `_'
I1 Ii
I
[I Check here if additional Deficiencies and Comments are listed on Form AES 9, Number attached:
1 'l 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"Defic9encies and Comments"section of this form.
Print Name / /
Signature I C�,7 Date --2,7 -/r
Form AES 20 Sept.3,2013