HomeMy WebLinkAboutFAI22-0002 CF Hood Inspection 2021 Were t Chemical Pre-Engineered Californian Code of Regulations -Title 19 Semi-Annual 1 of 2
Extinguishing System Insoection,Testing,and Maintenance Report , ��
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Property Information ti4( " p}� Contractor or Licensed Owner Information
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'Building Name rtv j,4 iiri 11 EvA4f✓ Name Wilgus Fire Control Inc.
'Address zj 5' y,,�� �� 5 j ar 9j �� Address 4544 Mountain Lakes Blvd.
' �. � City Redding St. CA Zip 96003
'City O f;v,.‘,l e„, 'License# 462979 (Phone 530-241-2465
'Contact Person hGue Cik+i g y vf—( ❑ SFM (Job#
'Phone 7/2 15/( £i 32 1,2/"l I ® CSLB !Misc.
^ .? iitillip llji )lil rill J"IIIIII,II ill 1 1
n E 1 • t-.
Cylinder Size '3 �,/, L Last Hydrostatic Test Date j Flow Points Capacity Used /0
System Location V i T�.G,.. System Mfr. 4Iv5.41 L Model# .K(d'2—
Fuel/Heat Shut Off: ,'
"Gas# J Electrical# Integral Make Up Air Shut Down
Items I #of Items I Dimensions Nozzle Nozzle Nozzle Total
Model# I Flow Points Qty' Flow Points
(Hoods i i Li 4 "i i I I
'Plenums " I I i r, I I I / I /
(Ducts I i I $aC / I 2,(;L I Z I / I
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Nozzle Nozzle Total Nozzle I Nozzle i Total
Appliance Name Appliance Name
Model Flow Points ''Flow Points Model Flow Points I Flow Points
e r t r-- I i� 3 I I
kf r� o I iA I i I i II
r-,n __.,r ✓ I it,'' I I :3 I
rII I I
I II I I [ I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Mfr Install I Mfr Install
ITemp Quantity Temp
Quantity
Date Dale
i I �Gz>% Date 1 z Datei I I
I I I I I I I I
Inspection,Testing, and Maintenance 44"`
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applic:ab;e
Item 1 I Description 1 ed. AReference
CA Date ( Comments Only 1 P,F,NIA
I ed.Reference
Manual Actuators are Unobstructed
1.1 I (i.e. Remote Pull Station) I 7.2.2(2) I I I P
1.2 II I Tamper Indicators&Seals Intact I 7.2.2(3) , I I
1.3 ( I IMaintenance Tag in Place I Title 19 906� I I i',,,_.
1.4 I I 'No Obvious Physical Damage 1 7.2.2(5) I I
1.5 ( I 'Gauge Readings within Proper Limits 2(6)2' 7I j��
(Stored Pressure) I)
1.6 I 1 'Blow-Off Caps in Place&Undamaged I 7.2.2(7) I
1.7 I 1 'Hoods,Ducts, Filters in Place and Clean I CFC 904.11.6.3 II f
1.8
I (Hood, Ducts& Protected Cooking Appliances Have I 722O
.. I I
I Not Been Replaced,Modified or Relocated 8
2.1 I T [AutomaticCI 7.3.3.4 ( ( � ._
Detection/Manual Actuation Functioned
Correctly
Form AES 20 Sept. 3,2013
e-"�°1 ! gineered California Code of Regulations Title 19 Semi-Annual`" 2 of 2
t' hinO System Inspection,Testing,and Maint4nanoe't Report
Property Information Contractor or Licensed Owner Information
1,q;r ?9
c, t 1,
'Building Name F � r f+,"^.t f� ' —,fi 1...,
Name Wilgus Fire Control Inc.
"Address ) (-53 !r ,0,4�. l/.S�M. {}'� ,,y .,, .7 Job#
City 0 (012 t /,4 .
���MP
Inspection, Testing,and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item '` Da+ W >' pt',_ #IA.
�� �' �>a..�;.����,,:. � � °� ,. .��` Ji 1V+"���� � Rl! k'
2.2 T Fuel Shut-Off Operated Correctly 7.3.3.4 P
2.3 I T jRegulator Tested&is within Acceptable Limits 7.3.3.4 I I k`
Manual Reset Relay Functioned Correctly 2.4 I T 7.3.3.4 //4
(If Applicable) I /1//
3.1
(All Agent Containers within Acceptable Hydrostatic I I
ia
M 7.5.1 1
Test Dates
3.2 M All Auxiliary Pressure Containers and/or Hose 7 5 1 2 3
ssemblies within Acceptable Hydrostatic Test Dates
I3.3 M `Cartridge Weights within Acceptable Limits 7.3.3.1(2) I I P I
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2) I I J (Non-pressurized) ti
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1{2}
I (Non-pressurized) I ( (if
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) I
3.7 M Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) I I I AP
3.8 M 'Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3 4 I ( I y
'Fixed-Temp(Other Than Fusible Metal Alloy Type)& I I I t,(�/A
3.9 M Heat Detectors Maintained or Replaced 7.3.5 ,IJ 4,
Auxiliary Equipment Such as Water valves
3.10 M IFunctionedCorrectly 7.3.3.1(2) ( I Its,%
3.11 I M 'Internal Maintenance as Required by Manufacturer Title 19§904.7 I I IN U /?'
~D= Deficiency C=Comment (Indicate type) { ys¢ y�yt�y�a Continents�j y y�
i e wuciencies an, CVininents 3�' S J .', ;fr
,- -4,,,, , � tndi ate all equipment,devices and parts that were waked orreplace t _
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I 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 lire 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.
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Print Name I i'pf'.Or‘b A. "- ovL(l Cirr
Signature I Date f�La 7, Z tI
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Fnrm AFS 30 Sent 3.2013