HomeMy WebLinkAboutFai21-0014 CF Hood Inspection 2021 Las Plumas Cafeteria Kit. Hood 10.28.21 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 C4op.\F Contractor or Licensed Owner Information
'Building Name Las Plumas High School Cafeteria r 1a i Name Voltage Specialists
(Address 2380 Las Plumes Ave +fii ____� ��� Address 370 Apple Lane
' >> F �`=— City Paradise St. CA Zip 95969
ICityOrovile !License# 880862 1Phone (530)624-4514
'Contact Person Bill I ❑ SFM 'Job#
'Phone 530 592-5599 I ❑■ CSLB 'Misc.
•ystem Information
Cylinder Size 3 Gal Last Hydrostatic Test Date 2020 Flow Points Capacity Used 8
'System Location Right of hood System Mfr. Ansul Model# R102
(Fuel/Heat Shut Off:
'Gas# Electrical# Integral Make Up Air Shut Down
Items #of Items Dimensions Nozzle Nozzle Nozzle Total
Model# Flow Points Qty Flow Points
Hoods 1 14' - - - 0
(Plenums II 1 I 7' I 1 N I 1 I 1 I 1
(Ducts II 1 I 2'X 2' I 2W I 2 I 1 I 2
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name Nozzle Nozzle Total Appliance Name Nozzle Nozzle Total
Model Flow Points Flow Points Model Flow Points Flow Points
Gas Char 1 N 1 2 ! !
Griddle I 1 N ! 1 ! 1 ! ! II 1 I
Range I 1 N ! 1 ! 2 ! ! II II I
1
Fixed Temperature Sensing Elements
(such as Fusible Links)
Quantity Temp Mfr Install Quantity Temp Mfr Install
Date Date Date Date
2 450 2021 10/28/21 I I I
I I
Inspection, Testing and Maintenance lir MA
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Item Description NFPA CA Date Comments Only P,F,N/A
ed.Referfer CA
1.1 I Manual Actuators are Unobstructed 7 2 2(2) 10/28/21 P
(i.e. remote pull station)
1.2 I 'Tamper Indicators&Seals Intact 7.2.2(3) 110/28/21 I I P
7.2.2(4)
1.3 I Maintenance Tag in Place Title 19 906� 10/28/21I
P
1.4 I INo Obvious Physical Damage 7.2.2(5) 110/28/21 I I P
1.5 I (Ga(Storeduge Readingspressure)within Proper Limits ! 7.2.2(6) I I I N/A
1.6 I IBlow-off Caps in Place&Undamaged 7.2.2(7) 110/28/21 I I P
1.7 I 'Hoods, Ducts, Filters in Place and Clean CFC 904.11.6.3 110/28/21 I I P
1 8 I (Hood, Ducts&Protected Cooking Appliances Have ! 7 2 2(8) 110/28/21 I Appliances have been moved I F
Not Been Replaced, Modified or Relocated
2 1 T !Automatic Detection/Manual Actuation Functioned ! 7.3.3.4 110/28/21 I I P
Correctly
Form AES 20 Sept.3,2013
Wet Chemical Pre-Engineered California Code of Regulations -Title 19 Semi-Annual 2 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
OF CiTLIN
Property Information :�� 'gyp of Contractor or Licensed Owner Information
Got
(Building Name Las Plumas High School Cafeterias iI (Name Voltage Specialists
(Address 2380 Las Plumes Ave j �i IJob#
\,?EMR�r
(City Orovile ,, _ I
Inspection,Testing and Maintenance
= Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Item Description NFPA CA Date Comments Only P,F,N/A
ed.Referfer CA
2.2 T Fuel Shut-off Operated Correctly 7.3.3.4 10/28/21 P
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 10/28/21 P
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4 N/A
(if applicable)
3.1 M All Agent Containers within Acceptable Hydrostatic 7.5.1(1) 10/28/21 P
Test Dates
3.2 M All Auxiliary Pressure Containers and/or Hose 7.5.1(2)(3) 10/28/21 P
Assemblies within Acceptable Hydrostatic Test Dates
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2) 10/28/21 P
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2) 10/28/21 P
(Non-pressurized)
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2) 10/28/21 P
(Non-pressurized)
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) 10/28/21 P
3.7 M Nozzles are Correct, Clean&Properly Aimed 7.3.3.1(2) 10/28/21 Nozzles need moved to the left F
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 10/28/21 P
3.9 M Fixed-Temp(other than fusible metal alloy type) 7,3.5 N/A
&Heat Detectors Maintained or Replaced
3.10 M Auxiliary Equipment Such as Water valves 7.3.3.1(2) N/A
Functioned Correctly
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904.7 10/28/21 P
D=Deficiency C=Comment (Indicate type)
It Deficiencies and Comments
Indicate all equipment,devices and parts that were repaired or replaced
3.7 10/28/21 ✓ Nozzles need to be moved left do to appliances being moved
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❑Check here if additional Deficiencies and Comments are listed on Form AES9 Number attached:
❑ See Correction Form AES 10 for corrected deficiencies. Number attached:
1 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 Randy Rader
Signature I � Date 10/28/21
Form AES 20 Sept.3,2013