HomeMy WebLinkAboutFAI18-0009 CF Suppression Hood Inspection 2021 Wet Chemical Pre-Engineered California Code of Regulations -Title 19 Semi-Annual 1 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
Property Information �oF Cq��`�,�1
p Y '/���`� _ 'Op9Z�,l Contractor or Licensed Owner Information
is
Building Name co 3 r� Name HAYDEN FIRE PROTECTION
�,. 7' Address
Address , y'�,cc\� >�'. 215 ZaneLLa Way #5
�`�'hREi.----`_ City Chico
_ st. Gp` Zip 95928
City License# Phone 1-800-417-0440
Contact Person ❑ SFM Job#
Phone is CSLB Misc.
Syster,t1 Information '
Cylinder Size Last Hydrostatic Test Date Flow Points Capacity Used
System Location System Mfr. Model#
Fuel/Heat Shut Off:
Gas# Electrical# Integral Make Up Air Shut Down
Items #of Items Dimensions 'lozzle Nozzle Nozzle Total
Y P,'odel# Flow Points Qty Flow Points ,j'
Hoods
Plenums
Ducts
Cooking Appliances
Left to Right with Saes and Coverage Nozzles
A liance Name Nozzle Nozzle Total Nozzle Nozzle Total
PP Model Flow Points Flow Poin:s Appliance Name Model Flow Points Flow Points
J
Fixed Temperature Sensing Elements
(such as Fusible Links)
Mr Install Mfr Install
I Quantity, Temp Quantity Temp
Dade Date - Date Date
Inspection,Testing and Maintenance;
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
item Description NFPA 17A CADate Comments Only P,F,N/A
ed. Reference
Manual Actuators are Unobstructed "—
1.1 I (i.e. remote pull station) 7.2.2O
2
1.2 I Tamper Indicators&Seals Intact 7.2.2(3)
1.3 I Maintenance Tag in Place 7.22(4)
Title 19 006 i
1.4 I No Obvious Physical Damage 7.2.2(5)
1.5 I Gauge Readings within Proper Limits
(Stored pressure) 7.2.2(6)
1.6 I Blow-off Caps in Place&Undamaged 7.2.2(7)
1.7 I Hoods,Ducts, Filters in Place and Clean CFC 904.11.6.3
Hood, Ducts&Protected Cooking Appliances Have
1.8 I Not Been Replaced.Modified or Relocated 7.2.2(8) t
2.1 T Automatic Detection/Manual Actuation Functioned 7.3.3.4
Correctly
Form AES 20 Sept.3,2013
Wet Chemical Pre-Engineered Califomia Code of Regulations -Title 19 Semi-Annual 2 of 2
I Fire.Extinguishing System Inspection, di
Testing,and Maintenance Report i.
Property Information SOF _ Ab Contractor or Licensed Owner Information
Building Name #co �' Name HAYDEN FIRE PROTECTION
Address 1- � �i'�/ Job#
City y\rrit Mp
Inspection,Testing ana Maintenance
Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
"lir(lettI T� t ti•;r .i r, 7 i.i1x r '''a ,:11� s q mr.R iT
i.A�v�1�.�-'t.ll.f.i.<��P r2t.��..�.}1 Ft tirit;_.>*i-•",fiF`p_-t,�3`ti"r.rV,`lfNxi 4 t.{i #�(_p ;., rr.�.vz>f✓'1p,,, l.',�B .t 8e Mfi�l+ F4l"ptt(n�,X,7 .'�' r?4.17.�r R;'r� 7.�J � °Ir , Z. Iy..�:..q� W 1_ ..� �3'... r r;,�4'_• _
ti
�lt f � G�t *z/5-j t !I!1 �.Vi.�Yr , t9i��. : I „ 1° i 114 {,;•1,
2.2 T Fuel Shut-off Operated Correctly 7.3.3.4
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4
2.4 T Manual Reset Relay Functioned Correctly 7,3.3.4
(if applicable)
3.1 M All Agent Containers within Acceptable Hydrostatic 7 5 1(1)
Test Dates
All Auxiliary Pressure Containers and/or Hose
3.2 M assemblies within Acceptable Hydrostatic Test Dates 7.5.1;2)(3)
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2)
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2)
(Non-pressurized)
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2)
(Non-pressurized) �:(..
I3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3)
3.7 M Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2)
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4
Fixed-Temp(other than fusible metal alloy type)
3.9 M &Heat Detectors Maintained or Replaced 7.3.5
3.10 M Auxiliary Equipment Such as Water valves 7,3.3.1(2)
Functioned Correctly
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904.7
D=Deficien C=Comment (Indicate type
Deficiencies and Commients fi
Item Date Riser D C �
Indicate all equipment,devices and parts that v,•ere repaired or replaced 11
110011111111111111
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dilIONIESSUP
❑Check here if additional Deficiencies and Comments are listed on Form AES9 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
Signature Date
Form AES 20 Sept.3,2013