HomeMy WebLinkAboutFAI21-0007 CF Hood Suppression System 2021 Wet Chemical PrEnghteered .
California Code of Regulations-Title 19 Semi-Annual
Fire Extinguishing System . trisPe ction;Testing�and Maintenance •• oto
AO i Contractor or Licensed Owner m
Property Information OF C4[i,�.
,� -/ eV 1.4;\,..1k, 1 Information
Building Name Memorial Hall �( '$ ' II
Name
Address 249 Sycamore St. ij Wilgus Fire Control Inc.
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l °�., 1, � Address 1703 Sonoma Street
‘7 -MP "' Cit
City '` �'" y Redding St. CA Zip 96001
GRIDLEY License# 462979 Phone (530) 241-2465
Contact Person
D SFM Job# 2221042121
Phone 538-7407 J CSLB
121111111111111111111111111111111111111111111
JE L.E . ,..,,.,. ysti+emtilit rrmattop
3 off
Cylinder Size
3gal fast Hydrostatic Test Date 2013 Flow Points Capacity Used
System Location Right side in hood System Mfr. Ansul8 1 21
Fuel/Heat Shut Off: Model# R102
Gas# Yes Electrical#
No Integral Make Up Air Shut Down NO
i
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Total� ilHoods8
Plenums 1 8' •
1N 1 1 1
Ducts 1 15" x 12" 2W -
2 1 2
Cooking Appliances
Left to RI.ht with
Sizes and Covera.e Nozzles
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i � ._� f.'E �l h 1t �n lF t0_. f eolo > 1 1$ .. _n. _., . *�. '�s ( : Tlou,.,Pr
tGriddle 2602 2
6 Burner Range 1F 1 3
•
Fixed Temperature Sensing Elements
aimm s. ,F,,.,;..n:... (Such as Fusible Links)
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3 360 2021 4� � ` J.: . Ca
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lrtspe#tion,Testing.arid Maintenance:. 9
I Inspection T Test M Maintenance t
wuyi yT P Pass F Far! N/A Not Ap.lrcable
Kernk.
t 9 EE pf i fl 9 t 6 T.�, A
y d
� '.° "., >.s.-..m P i jam,..: 9 ..q.. $ S Y _°�'� _�S� �C �. f �1,�{,r�
Manual Actuators are Unobstructed
11111.11111 i.e. Remote Pull Station El= 1111111.111111 4/21/2021
P
Em Tamper Indicators&Seals Intact
7,2.2, 4/21/2021
4 P
11111 1111 Maintenance Tag in Place O 412112021
Title 19 .906 p
1111 1111 No Obvious Physical Damage 7.22(5) 4/21/2021
�ii Gauge(Stored Readings within Proper Limits P
7.2.2(6) 412112021
N/A
1.6 III Blow-Off Caps in Place&Undamaged 7.2.2(7) 4/21/2021
P
��11111111 Hoods,Ducts, Filters in Place and Clean CFC 904.11.6.3 44/21/2021/21/2021
Hood, Ducts&Protected Cooking Appliances Have p
Not Been Re.laced Modified or Relocated 7.2.2(8)
111111111' P
utomatic Detection/Manual Actuation Functioned 4/21/2021
Correct! 7.3.3.4IIIIIIIIIIIIIIIIIII P
Form AES 20
Sept.3,2013
'diet demi /Pre-Engineered California a Code of RegulationSemi-Annual s-Title 192 of 2
..
Extinguishing System Inspection,Testing,and Maintenance Report
�..
Of CA4/� Contractor or Licensed Owner Information
Property information174.117,---'—j."–'4,..0
--' ; ' ,`.0It
co N't?�
Building Name Memorial Hall i , € Name Wilgus Fire Control Inc.
ti /� lob# 2221042121
Address 249 Sycamore St. 1t �r
k SIRE S pP4-
City GRIDLEY �
Inspection,Testiing,and Maintenance
P=Pass F=Fail N/A=Not Applicable
I Inspection T Test M Maintenance g� � ;
y a
1;tLEI`;`i, ._- a 8a.:..a.�e a�e�a�1°'6'c°...@°":z¢n'^',.�f:��a o�vnse;i¢`�°B'�°�€¢�w.;=d°i",.,gww�:ere°k°?�0;�1� ... ...,aa �,%�d` �.,� 0Jio,...;:.%,:,,,..,..,,,,,..
.... ,� a--o;a„. •*°_`="- 421/202 P
2.2 T Fuel Shut-Off Operated Correctly 7.3.3.4
4/21/2021 N/A
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4
Manual Reset Relay Functioned Correctly4/21/2021 NSA
2.4 T 7.3.3.4
(If Applicable)
All Agent Containers within Acceptable Hydrostatic 7.5.1(1) 4/21/2021 Q
3.1 M g
Test Dates
*All Auxiliary Piessure Containers and/or Hose 7 5 1(2)(3) 4/21/2021 p
3.2 M Assemblies within Acceptable Hydrostatic Test Dates -
4121/2021 p
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2)
Liquid Level within Acceptable Limits7.3.3.1(2) 4(21/2021 p
3.4 M (Non-pressurized)
No Signs of Corrosion in Agent Cylinder 7.3.3.1(2) 4/21/2021 p
3.5 M (Non-pressurized) ,
4/21/2021 p
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3)
4/21/2021 P
3.7 M Nozzles are Correct,Clean &Properly Aimed 7.3.3.1(2)
4/21/2021 p
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4
Fixed-Temp(Other Than Fusible Metal Alloy Type)& 4(21/2021
laced N/A
3.9 M 7.3.5
Heat Detectors Maintained or Rep
Auxiliary Equipment Such as Water valves7.3.3.1(2) 4/21/2021 N/A
3.10 M Functioned Correctly
4/21/2021 N JA
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904.7
D=Deficient C=Comment Indicate type)
d ; Peffoienoles and Comments .r ..' •
indicate ati equip.nent-devicas andpptts that weta repairedorreplaced
0Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
0 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 Joshua Goodrich
Signature Date 4/21/2021
Form AES 20 Sept.3,2013