HomeMy WebLinkAboutFAI21-0007 CF Hood Suppression 2021 Wet Chemical Pre-Engineered California Code of Regulations -Title 19 Semi-Annual 2 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
Property Information kt. 4•-!,p 4 Contractor or Licensed Owner Information
i .it '11 i
'Building Name Memorial Hall i Name Wilgus Fire Control Inc.
'Address 249 Sycamore St. #t111, 4 Job# 2221110921
'City GRIDLEY ‘ i �p ,
Inspections Testing, and Maintenance
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
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2.2 I T IFuel Shut-Off Operated Correctly 7.3.3.4 11/9/2021 P
11/9/2021
2.3 I T 'Regulator Tested&is within Acceptable Limits 7.3.3.4 N/A
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4 11/9/2021 N/A
I 'Manual
Applicable) I
3.1 I M 'All Agent Containers within Acceptable Hydrostatic 7 5 i t) 11/9/2021 P
Test Dates
3.2 M 'All Auxiliary Pressure Containers and/or Hose 7,5.1(2)(3) 11/9/2021 P
ssemblies within Acceptable Hydrostatic Test Dates
11/9/2021
3.3 I M 'Cartridge Weights within Acceptable Limits 7.3.3.1(2) P
3.4 I M 'Liquid Level within Acceptable Limits 7.3.3.1(2) 11/9/2021 P
(Non-pressurized)
3.5 I M INo Signs of Corrosion in Agent Cylinder 7.3.3.1(2) 11/s/2021 P
(Non-pressurized)
3.6 ' M 'Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) 11/9/2021 P
11/9/2021
3.7 I M 'Nozzles are Correct, Clean&Properly Aimed 7.3.3.1(2) P
3.8 I M 'Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 11/9/2021
P
3.9
' M 'Fixed-Temp(Other Than Fusible Metal Alloy Type)& 11/9/2021
Heat Detectors Maintained or Replaced 7.3.5 N/A
3.10 I M Auxiliary Equipment Such as Water valves 7.3.3.1(2) 11/9/2021 N/A
Functioned Correctly
11/9/2021
3.11 I M 'Internal Maintenance as Required by Manufacturer Title 19§904.7 N/A
D=Deficiency C=Comment (Indicate type)
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F m' ,,- •`' D _ ee iciencies an. arnmen s
,v �:. indicate all equipment,devices and parts that were repaireJ' _, ,cac
I
I
Li Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
[l 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 Joshua Goodrich
Signature I Date 11/9/2021
Form AES 20 Sept.3,2013
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 ,�� �"�A�'-ptl; Contractor or Licensed Owner Information
Building Namej3k �`Memorial Hall �� � ��� Name Wilgus Fire Control Inc.
nc.
Address 249 Sycamore St. Q. Address 4544 Mountain Lakes Blvd.
All MR` City Redding St. CA Zip 96003
City GRIDLEY (License# 462979 'Phone (530) 241-2465
Contact Person I ❑ SFM (Job# 2221110921
Phone 538-7407 ' ❑X CSLB !Misc.
» � m-
.u:,: Sy stern Information
•Cylinder Size 3 gal Last Hydrostatic Test Date 2013 Flow Points Capacity Used 8 of 11
(System Location Right of hood System Mfr. Ansul Model# R102
(Fuel/Heat Shut Off: I
'Gas# Yes Electrical# No Integral Make Up Air Shut Down YES
3 4 ba�; 5 -
3 i
��� ,', ..r, . ;;:^ .. a-;:.r A:� t ' >=1ow Paints
(Hoods I.......: 8' I
Plenums I 1 I8' I 1 N I 1 I 1 I 1
(Ducts I 1 I 12" x 15" I 2W I 2 I 1 I 2
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name,„„ L Modei FlowP I, Nozzle nts Flow Points Appliance Name > Model Flow
l Total
Nozzle,,
Points Flow Points
Griddle I 245 2 2 1
6 burner range I 1F 1 I 3 I I I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity Temp ' Date i IDat l Quantity I Temp r Date IDatel'
3 +I 360 I 2021 I 11/2021 11 I
Inspection, Testing, and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Pig ��,; r 3' I N PA 1(7A CA J
ts� fO( � A� i� '1 - ecl:-Rsference, Qafe _ Ccim�henny P,F,NiA
1.1 I Manual Actuators are Unobstructed 7 2 2(2) 11/9/2021 P
I (i.e. Remote Pull Station)
P I I 11/9/2021 I I
1.2 I Tam er Indicators&Seals Intact 7.2.2O
3 P
1.3 ( I 'Maintenance Tag in Place ( Title 19(§906 I 11/9/2021 I I P
1.4 I INo Obvious Physical Damage I 7 2 2(5) I 11/9/2021 I I P
1.5 I Gauge Readings within Proper Limits 7 2 2(6) 11/9/2021 N/A
(Stored Pressure)
1.6 ( I IBlow-Off Caps in Place& Undamaged I 7 2 2(7) I 11/9/2021 I I P
1.7 I (Hoods, Ducts, Filters in Place and Clean I CFC 904.11.6.3 I 11/9/2021 I I P
1 8 I (HoodNot , DuctsBeenReplaced,&ProtectedModi Cooking
fiedorR Applianceselocated Have I 7 2 2(8) I 11/9/2021 I I P
2.1 T 'Automatic Detection/Manual Actuation Functioned 7.3.3.4 11/9/2021 P
(Correctly I I I I
Form AES 20 Sept.3,2013