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HomeMy WebLinkAboutFAI19-0018 CF Hood Inspection 2021 - I • . •I - • . -i. • it : l • -. - • v. , .. . Fire Extinguishing System Inspection,Testing,and Maintenance Report Property Information 1/:(2- �F CA �` p'P i, Contractor or Licensed Owner Information (Building Name U1,,yat 7fte 6);( 01 0(C ID i Name Wilgus Fire Control Inc. (Address 11 q 10 f`ao j,/,`/ /Lr,<./ 4, 1.,,,c�� P�� Address 1703 Sonoma St. ' MP_. ��,__ _ City Redding St. CA Zip 96001 ICitY 05%,/,'//,- (License# 462979 (Phone 530-241-2465 (Contact Person 665 a I ❑ SFM (Job# (Phone c qq. 59 3 2_ ,7d I ® CSLB 'Misc. System Information Cylinder Size err Last Hydrostatic Test Date 0/'-,-7) Flow Points Capacity Used 'System Location /<(7 e. - System Mfr. ,4 V c5 aC Model# 1{ /O% (Fuel/Heat Shut Off: k 'Gas# V Electrical# Integral Make Up Air Shut Down Items I #of Items I Dimensions I Nozzle I Nozzle I Nozzle Model# Flow Points QiyTotal Flow Points 'Hoods I / I L/ X / 2, I I I I (Plenums I / I I I Al I I I 4_ I 'Ducts I , I I S >4 IS I 2.G) I 2-, I / I 2_. Cooking Appliances Left to Right with Sizes and Coverage Nozzles Nozzle I Nozzle Total I Nozzle Nozzle Total Appliance Name Model Flow Points Flow Points Appliance Name Model Flow Points Flow Points I (- --Is•)eAA 1-' 1 i,-' I I I I I I I LC- Aj- Y 1s' I I I .3 I1- - / it/ 11 I r II I I I II I I I II I Fixed Temperature Sensing Elements (Such as Fusible Links) Mfr Mfr Quantity I Temp I Date I IDatel Quantity I Temp ' Date I InstallDate '3 I -3 i e I Z- I / I I I I I 1 I I I II I I I • Inspection,Testing, and Maintenance 1 = Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable ;,mow_-- I Item Description NFPA 17A CA ed. Reference Date I Comments Only I P,F,N/A 'Manual Actuators are Unobstructed ' ( ) I I I �/ 1.1 I (i.e.Remote Pull Station) 7.2.2 2 1.2 I (Tamper Indicators&Seals Intact I 7.2.2(3) I I I F 1.3 I (Maintenance Tag in Place I Title 19(4906 I I I /I 1.4 I INo Obvious Physical Damage I 7.2.2(5) I I I V Gauge Readings within Proper Limits ( ) / 1.5 I (Stored Pressure) I 7.2.2 6 I I 4 1.6 I (Blow-Off Caps in Place&Undamaged I 7.2.2(7) I I I 1.7 I (Hoods,Ducts, Filters in Place and Clean I CFC 904.11.6.3 I I I i 'Hood,Ducts&Protected Cooking Appliances Have I (8) 1.8 I Not Been Replaced.Modified or Relocated 7.2.2 2 1 T 'Automatic Detection/Manual Actuation Functioned I 7.3.3.4 I I I )1(Correctly • Form AES 20 Sept.3,2013 I lop,II I,• . . p i .. .i • 1 •• : • ' • i . r t v. I i ill Fire Extinguishing System Inspection,Testing,and Maintenance Report • Property Information k*',a- cqo • Contractor or Licensed Owner Information y% 9Z 'Building Name W4.ac d/K Cs,'a, ,�, �y Name Wilgus Fire Control Inc. (Address 41 2/ F�0 ),1 y/ �� / �, .e- Job# 'City ©✓ou..Li✓ ARE N1 e Inspection, Testing, and Maintenance I =Inspection T =Test M=Maintenance P=Pass F=Fait N/A=Not Applicable NFPA 17A CA Item I , Description I Date I Comments Only I P,F,N/A ed.Reference 2.2 I T 'Fuel Shut-Off Operated Correctly I 7.3.3.4 I I I f 2.3 I T 'Regulator Tested&is within Acceptable Limits I 7.3.3.4 I I 16-"' 2.4 T Manual Reset Relay Functioned Correctly I 7,3.3.4 (If Applicable) a/ 31 I M 'All Agent Containers within Acceptable Hydrostatic I 7.5.1(1) I I I Uf Test Dates 3.2 I M /� tAll Auxiliary Pressure Containers and/or Hose I 7.5.1(2)(3) I I I v ssemblies within Acceptable Hydrostatic Test Dates 3.3 I M 'Cartridge Weights within Acceptable Limits I 7.3.3.1(2) I I I 3.4 M Liquid Level within Acceptable Limits (Non-pressurized) I 7.3.3.1(2) /� I I IU 3.5 M _ INo Signs of Corrosion in Agent Cylinder (Non-pressurized) 7.3.3.1(2)I I I I Al 3.6 ' M 'Distribution Piping Unobstructed and Contiguous ' 7.3.3.1(3) ' I I66" 3.7 I M 'Nozzles are Correct,Clean&Properly Aimed ' 7.3.3.1(2) ' I 3.8 I M 'Fixed Temp Fusible Metal Alloy Type Detectors Replaced' 7.3.4 I I I(� IFixed-Temp(Other Than Fusible Metal Alloy Type)& I I I 104 3.9 M Heat Detectors Maintained or Replaced 7.3.5 yJ� 3.10 I M 'Auxiliary Equipment Such as Water valves I 7.3.3.1(2) I I Yv��Functioned Correctly /�/ 3.11 I M Internal Maintenance as Required by Manufacturer I Title 19 §904.7 I I 'fv�� D=Deficiency C=Comment (Indicate type) Item Date Riser D C Pe�crencres an:' ommen s Indicate all equipment,devices and pads that were repaired or replaced I I I _I I I illI I I I _ I I I I I I .1 I I I N I I CI I I I I I El 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 iniihe"Deficiencies and Comments"section of this form. Print Name I //f Aha.e N,,,.acpT 1 Signature I Date -A7 .z. rI t, Form AES 20 Sept.3,2013