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HomeMy WebLinkAboutB18-0853 CF Suppression Hood Inspection (2) W' U?1 ''- sys4cw1 Fire Extinguishing System Ins'•ction,Testing,and Maintenance Report Property Information /AY/F CAL,'cp yc Contractor or Licensed Owner Information 'Building Name -me ��,} \ �f IName HAYDEN FIRE PROTECTION 'Address 6bla btpct Ln I�t93� � . of !Address15108 JACK PINE WAY I ‘‘‘ IIM MP=- 'City MAGALIA St. CA Zip 95954 'City j1/Ic,cte.lcw ILicense# !Phone 1-800-417-0440 'Contact Person jo'vo I ❑ SFM IJob# 'Phone cite, -'4•7'10 /au —q`iO3 I ❑� CSLB 827131 IMisc. • Cylinder Size 3ak� , gem, Last Hydrostatic Test Date fQjoq, 2.001 Flow Points Capacity Used 11:1 'System Location 'P:dr hin- System Mfr AtnSc-1 Model# 2-/CZ IFuel/Heat Shut Off: 'Gas# l Electncal# Integral Make Up Air Shut Down It b Ffil altar)" I :Wrensioa I I ' •� f' FI Pu1: : . . . . . � :. - Matta ..Fow�r�-s . „ Qv IHoods I I I450N'br' I I I I 'Plenums I I I Pr fe Pr I IA) I 1 I 2_ I 2 IDucts I 2 I i3'irci"/13'k13'1 21ki I Z I 2 I Li Cooking Appliances Left to Right with Sizes and Coverage Nozzles '' - ,',fi -- .., 4 Ice Nerve _ .Nortts� . . 1Yoizle a .`l �F..,t� I 2 A 0 I 2 I 2 II 12w,,.e I IF, IF.IF I 'S Fryer I 710 I 2- 12 I I Cisau(brukar I tiv l I I 6A:1L`)c. I IA/ 11 I 1 II I I CdaJtlle. I 2w - I Z. I 2 I I I I tasidiqc. IrniGrq) Iyi l•- z II I I Fixed Temperature Sensing Elements f t (such as Fusible Links) I Qua*, 'I :` .sTrn.P .' .I t3 I Date? : ' .. Quantify I Temp I � . ( : .Ir> 5 14,n I 2nIS I ii-21--Ie I I I I I I I I II I I I Inspection, Testing and Maintenance I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable NAM 17A CA. Item Description Reference .' , Commas only P.P Nei! Manual Actuators are Unobstructed 1.1 (i e remote pull station) 7 2 2(2) tl.2s-19 P 1.2 I Tamper Indicators&Seals Intact 7 2.2(3) 4-25-•-le P 1.3 I Maintenance Tag in Place 7.2 2(4) !I-25-te Title 19 S906P 1 4 I No Obvious Physical Damage 7 2 2(5) q-2 --It P 1 5 I Gauge Readings within Proper Limits 72 2(6) rt-ZS"-IQ �} (Stored pressure) /.1 1 6 I Blow-off Caps in Place&Undamaged 7 2 2(7) c'-ZS-le 1 7 I Hoods, Ducts, Filters in Place and Clean CFC 904 11 6.3 rf-ZS-1€ P Hood, Ducts&Protected Cooking Appliances Have 1 8 Not Been Replaced, Modified or Relocated 7 2 2(8) q 2S-t- 2 1 T !Automatic Detection/Manual Actuation Functioned 7.3.3.4 -25.-I6 'Correctly Form AES 20 Sept 3,2013 u p c Sys1cwt • . . - . Fire Extinguishing System Inspection,Testing,and Maintenance Report Property Information S1/`�/uF CA(/�O y Contractor or Licensed Owner Information ik 9r4r 'Building Name �L D,pa.} ( nr 'Name HAYDEN FIRE PROTECTION 'Address 4SIS beoc} Ln t1 i;e` � Pit 'Job# `y MP_= 'City Mnaw.Iin `` Inspection,Testing and Maintenance =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable f �,�" q- 4PWV in :t. =� • .. Deseriptfon SRNorsnceA I ,:Date, �.. Command Qnjy !SAX A 2.2 T Fuel Shut-off Operated Correctly 7 3 3 4 I f) 2.3 T Regulator Tested&is within Acceptable Limits 7 3.3 4 9-25-18 I At IA 2 4 T Manual Reset Relay Functioned Correctly 7.3.3 4 -ZS-/Y I NI,4 (if applicable) 3 1 M All Agent Containers within Acceptable Hydrostatic 7 5 1(1) n•2S-Ifs I P Test Dates 3 2 M (AII Auxiliary Pressure Containers and/or Hose 7 5 1(2)(3) H-LS-fQ �gssemblies within Acceptable Hydrostatic Test Dates N 3 3 M Cartridge Weights within Acceptable Limits 7 3.3 1(2) r1-2S-fti goo/ kuiAt.I P 3 4 M Liquid Level within Acceptable Limits 7.3 3 1(2) n•2S-' I P(Non-pressurized) 3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2) r(-2S-ram I P (Non-pressurized) 3 6 M Distribution Piping Unobstructed and Contiguous 7.3 3 1(3) r(-2S-ib I P r(3.7 M Nozzles are Correct,Clean&Properly Aimed 7 3 3 1(2) .2S-;9. D I f 3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3 4 q,25-1y', I P 3.9 M Fixed-Temp(other than fusible metal alloy type) 7 3 5 -25 -f`✓ INb4 &Heat Detectors Maintained or Replaced 3 10 M Auxiliary Equipment Such as Water valves 7 3 3.1(2) (1-25"-) I Nfrt Functioned Correctly 3 11 M Internal Maintenance as Required by Manufacturer Title 19§904.7 R 45--iS I /t/(/4 D=Deficiency C=Comment (Indicate type) Item Date Riser D C Deficiencies and Comments Indicate all equipment,devices and parts that were repaired or replaced C.25-18 Sys km Nat 1 )c.c Neel. ii1 ❑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 gyo„ k;ek9. Signature I �L'7� /` Date 01-25 -lt3 Form AES 20 Sept.3,2013 t Lois( 5y54411. • Fire Extinguishing System Inspection,Testing,and Maintenance Report - Property Information /:9!c4c/* y1 Contractor or Licensed Owner Information AT/ (Building Name g tk- r e/ ��' n/ (Name HAYDEN FIRE PROTECTION 'Address �pthe btt-% 'Lv. 4?� �g?i (Address15108JACKPINEWAY 1 1..,CRE Ml'L_- ICity MAGALIA St. CA Zip 95954 (City Macu,l;a (License# (Phone 1-800-417-0440 'Contact Person ,lnt,„h I ❑ SFM IJob# I 'Phone at,‘, -a 7 etc/sit-9go3 IN CSLB 827131 'Misc. Cylinder Size 34a I Last Hydrostatic Test Date• 2/117 Flow Points Capacity Used ~I 'System Location iY.i-If.t,r.n System Mfr. Ar..51.1 Model# 12-102 I (Fuel/Heat Shut Off: I IGas# I Electrical# Integral Make Up Air Shut Down I ;. r a ( s; k f Nozzle Nozzl& Tolal `_- 77.E ': . I < I DrrnerJPl2ns,€ I s -M I, ROW Points I Oty '., . I: Flaw Rdint+.'. Hoods I I I 7'u Y;Lr� I L I I I I (Plenums I I I -t t6" I (A) I I I 1 I I I IDucts I I I 16"x16" I 1,1,J I Z. I I I 2 1 Cooking Appliances Left to Right with Sizes and Coverage Nozzles L. NozxJe r - ' a• od6l f NOVO, 1?�lv+ tlr#a`' -.;:1-,, N. ame .I , ozzla 'I E1pwPaMa (Dills 15 M P-a,A,e I uo. 2Lo I '2. s-/ I I I I I I I II I I I I I I I II I I I I I I I II I I I I Fixed Temperature Sensing Elements (such as Fusible Links) Q1 IIt / ;. Iry< lei Mir .: Date I (Date,-- ` Quantdy -1 Temp I I Insta1,, 2- I bsn I 701» 19 24 -1I I I I I I I I I II I I I Inspection, Testing and Maintenance I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable m f� -s I' r Description . -. edPReterence I Date Comments Only I P,F,NFA. Manual Actuators are Unobstructed 1 1 (i.e remote Dull station) 7 2.2(2) ti-27f"lL'' rp 1 2 I Tamper Indicators&Seals Intact 7 2.2(3) 9-l5 .113 1 1.3 I Maintenance Tag in Place 7 2.2(4)Title 19 F906 9"2 5-15 P 1 4 I No Obvious Physical Damage 7 2 2(5) rl-24-113 P 1.5 Gauge Readings within Proper Limits 7 2.2(6) Cl-2y-1d Af(ft (Stored pressure) 1.6 I Blow-off Caps in Place&Undamaged 7.2.2(7) q-26-lti P 1.7 I Hoods, Ducts, Filters in Place and Clean CFC 904.11.6.3 9-26 -1A p 1.8 I Hood, Ducts&Protected Cooking Appliances Have 7 2 2(8) q45-1$ P Not Been Replaced. Modified or Relocated 2.1 T !Automatic Detection/Manual Actuation Functioned 7 3 3 4 9-25-IQ Correctly I Form AES 20 Sept 3,2013 * L ,Lotr Sy34.er.l Fire Extinguishing System Inspection,Testing,and Maintenance Report Property Information .,��DF CA�r��4r Contractor or Licensed Owner Information f~P1 P40i y (Budding Name "(�.,z b-e ndf # \ n i IName HAYDEN FIRE PROTECTION (Address 4 tiller} 1� ttti i t'F\ ' P/r (Job# 'City {4'1 .i.w `�q�RP_= I`E M Inspection, Testing and Maintenance I =Inspection T =Test M=Maintenance [r CC P=Pass F=Fail N/A =Not Applicable -` '"t ; ' wiicriptian 1' � ne' :{I ate Comments©nljr... ; w 2 2 T 'Fuel Shut-off Operated Correctly 7.3.3.4 i-i5-It, P 2.3 T 'Regulator Tested&is within Acceptable Limits 7.3 3 4 4_15-I12 N/A 2.4 T 'Manual Reset Relay Functioned Correctly 7 3.3 4 N IA (if applicable) r1"Z5"Iy 3 1 M (All Agent Containers within Acceptable Hydrostatic I(TestDates 75.1(1) ci_n_te 3.2 M II Auxiliary Pressure Containers and/or Hose ssemblies within Acceptable Hydrostatic Test Dates 7 5 1(2)(3) ,2s--Ib NIA 3.3 M Cartridge Weights within Acceptable Limits 7.331(2) 1_25-id 2011 F 3.4 M Liquid Level within Acceptable Limits 7 3.3 1(2) 9 (Non-pressurized) O -is--I` 3.5 M No Signs of Corrosion in Agent Cylinder (Non-pressurized) 733.1(2) q"Z;"tt1 P 3 6 M Distnbution Piping Unobstructed and Contiguous 7.3.3 1(3) 1-75-_tP P 3.7 M Nozzles are Correct,Clean&Properly Aimed 7.3.3 1(2) ti"Z5"tN O 3 8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7 3 4 ci-25_IS rD 3.9 M Fixed-Temp(other than fusible metal alloy type) /�/�h &Heat Detectors Maintained or Replaced 7 3 5 q-25-tb 3 10 M Auxiliary Equipment Such as Water valves 7 3 3 1(2) 2 N IA Functioned Correctly �- S-IN, 3.11 M Internal Maintenance as Required by Manufacturer Title 19§904 7 q-z -Ib 7.1 i4 D=Deficient C=Comment (Indicate type) Item Date Riser D C Deficiencies and Comments Indicate all equipment,devices and parts that were repaired or replaced ..251E ' 5v54em nk.))- r7Lirne0 +I ❑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 I eyp,.. K;c ty0LK Signature I � Date q _2-5 '6 I Form AES 20 Sprit 1 91111