HomeMy WebLinkAboutFAI21-0009 CF FS 2021 Corrective Action California Code of Regulations -Title 19 1 of 1
and Repairs Performed Inspection, Testing,and Maintenance
s" A�!a Contractor or Licensed Owner Information
Property Information i,�Cv1 p
'Building Name CAL-FIRE BUTTE MEADOWS STA i.e f ));• Name Wilgus Fire Control Inc.
14r1(Address 7288 HUMBOLT RD. +ytA�U, a Address 4544 Mountain Lakes Blvd.
I N i E Mp City Redding St. CA Zip 96003
'City FOREST RANCH (License# 462979 'Phone (530) 241-2465
'Contact Person As per Captain Jorgensen I ❑ SFM !Job# 3044092921
'Phone (530) 873-3429 I [R CSLB 'Misc.
r ra a 'se,cren
Item cres and Comments ��
Form# Foaund Corrected indicate all equipment,devices and parts that were repaired or iaeed :
5/12 All quick response Sprinkler heads due for 20 year UL test or replacement
0047L1 ( Replaced all quick response sprinklers, refilled system
9/20/21 System passed inspection, all notated deficiencies from 5 year inspection repaired
Installed 275 Gal of pre mix GL48 glycerine/water
I
1
I
I hereby certify that the fire protection equipment listed above has been corrected in accordance
with CCR, Title 19,Sections 901 to 906 and that the equipment is fully operable.
Building Representative 1 Technician
As per Captain Jorgensen RUSTIN BARTH
Signature ' Date ` Signature ' Date
I 9/29/2021 I . :j 1
9/29/2021
i