HomeMy WebLinkAboutFAI16-0002 CF Sprinker Test 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 :µ aF`�AC/'cL`
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f,•,<<u�- p`�i Contractor or Licensed Owner Information
!Building Name i'ft~,"Ez 64„,te1}r. (' .i i 701
1 Name Wilgus Fire Control Inc.
'Address 1 f 1O UJ ,F,2 i)Atte Ii1"4� c�__, ,7 !Address 1703 Sonoma St.
Ni . - !City Redding St. CA Zip 96001
'City (./-426,U !License# 462979 !Phone 530-241-2465
'Contact Person I ❑ SFM IJob#
!Phone ' i' 2 7 R/-7, I 0 CSLB 'Misc.
• System Information
, ,s
Cylinder Size "5 ..„,:„ [ Last Hydrostatic Test pate /V Flow Points Capacity Used <, -
'System Location ' jlyr'7-4,4". System Mfr. A kl5t( _,... Model# ''10
(Fuel/Heat Shut Off: t.
Gas# Electrical# ,,,�. Integral Make Up Air Shut Down
Y Total
f�-i 1 ms { Flow Points==
J am" ../ —} — bI
1.41
Plenums I I I I Al I t I 2 I 2,Ducts I I I (i ' :Z. I -tL=' I �?_- I t I '.
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
' Nozzle Nozzle Total j� - Nozzle . Nozzle Total
Appliance Name Appliance Name � A,, -
NI IF... MOW Points Ploy�.Points Model,: Fly Points I Flow Points
rr v f'r,, t. ii,-.-n,. I I 1 - I '2) I I 1
t"'-i^' '!.., I i , I I i I I I I I
I I I I I I I
I I II I I I
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I I II I I I
Fixed Temperature Sensing Elements .
(Such as Fusible Links)
Mfr
QuantityTemp Datei!,, 6°� „ Quantity ° t11 ..� a Date Date
z.f I 1
I I I I I I I
Inspection, Testing,and Maintenance . .'
1 =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item I ' C z= , . . . ' date s �Com n 1 ` ; m
Manual ActuatorsareUnobstructed O >-_
1.1 } I I (i.e.Remote Pull Station) 7.2.2 2 I
1.2 I I 'Tamper Indicators&Seals Intact I 7.2.2(3) I I
1.3 I Maintenance Tag in Place 7.2.2(4} y
I I Title 19 4906 I I
1.4 I I INo Obvious Physical Damage I 7.2.2(5) I I I fr
1 5 I I (Gauge Readings within Proper Limits I 7.2.2(6) I I I, I
(Stored Pressure)
1.6 I IBlow-Off Caps in Place&Undamaged I 7.2.2(7) I I I ie_
1.7 I I 'Hoods,Ducts, Filters in Place and Clean I CFC 904.11.6.3 I I /
1.8 IHood, Ducts&Protected Cooking Appliances Have (8)
I !Not Been Replaced.Modified or Relocated I 7.2.2
2.1 I T utomatic Detection/Manual Actuation Functioned 7.3.3.4
Correctly I I I I
Form AES 20 Sept.3,2013
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Wet Chemical Pre-Engineered California Code of Regulations -Title 19 Semi-Annual 2 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
O!.Cati
Property Information ,is4 -'p Contractor or Licensed Owner Information
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!Building Name( '`t?r L,c, 1j�-4r,(7/}/t f ? ;s Cr1 C, T
' Name Wilgus Fire Control Inc.
!Address 1 ) (�) IV V it 4°1-I ,,4 t'.4.,. '�.;„ c'" Job# !
?E.N►P -
!CitY f l i i 0 x .. 1
Inspection. Testing,and Maintenance m
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item 'I ! ''y e rl ition ,>_,. 'lrilrit l'ts OnlyP,F,N/A
2.2 T !Fuel Shut-Off Operated Correctly 7.3.3.4 t°
2.3 T 'Regulator Tested&is within Acceptable Limits 7.3.3.4 I 4/14-
2 4 T Manual Reset Relay Functioned Correctly 7.3.3.4 I
'Manual
Applicable)
3.1 ! M !All Agent Containers within Acceptable Hydrostatic 7.5.1(1)
Test Dates
3 2 M �II Auxiliary Pressure Containers and/or Hose 7.5.1(2)(3)
Assemblies within Acceptable Hydrostatic Test Dates cif
3.3 M 'Cartridge Weights within Acceptable Limits ' 7.3.3.1(2) en.'
3.4 M 7.3.3.1(2)
Liquid Level within Acceptable Limits
(Non-pressurized) I ! 19,7
3.5 M INo Signs of Corrosion in Agent Cylinder 7.3.3.1(2) ! �'
(Non-pressurized)
3.6 M 'Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) ;1
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
3.9 M H
!Fixed-TempeatDetectors(Other ThanMaintained FusibleorReplaced Metal Alloy Type)&
7.3.5 (/
I
Auxiliary Equipment Such as Water valves
3.10 M !Functioned Correctly 7.3.3.1(2) /4
3.11 M !Internal Maintenance as Required by Manufacturer Title 19§904.7 /4. /4.
D=Deficiency C=Comment Indicate t •e
ItN1 'nbateRiser DC
Deficiencies and Comments
� Indicate all equldmehf,devices and parts that were repaired,.-Jr reptaced
L I I-.. ---1
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Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached.
I 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 1 F c,'7'a✓ k , 0 4._Signature' ~- Ifi Date f/ _ I
Form AES 20 Sept.3,2013