HomeMy WebLinkAboutFAI15-0057 CF FA and CF Sprinklers 2022 Fire Alarm Zone List Pg 1 ori—
Name: BANGOR UNION SCHOOL Acct Number: 809-9256
Address: 7549 Oro Bangor Highway Install Date: 5-9-12
City: Bangor, Ca 95914 Premise Phone#: 530-679-2434
Primary Panel Phone#:530-679-1611
Signals Sent? Y / N Online? Y / N Secondary Panel Phone#:530-679-1606
Panel Type: Silent Knight 5820XL_ Location: SCHOOL OFFICE
Breaker Number&Location: PANEL C3 #24 (SPECIALISTS ROOM)
Annunciator Type:N/A
Inspectors Test Valve Location: RISER
Rpt Device Device Device Soft Zone/
Zone# Type Location Address Information
1 SMOKE GYM GIRLS RESTROOM 1 1
2 SMOKE GYM BOYS RESTROOM 2 1
3 SMOKE GYM JANITOR CLOSET 3 1
4 PULL STATION MAIN CAMPOS PULLS On cpu#4 1
5 PULL STATION PORTABLES PULLS On cpu #5 1
6 PULL STATION GYM NORTH EXIT PULL 6 1
7 SMOKE GYM FLOOR SMOKE • 7 1
8 SMOKE GYM FLOOR SMOKE 8 1
9 SMOKE GYM FLOOR SMOKE ` • 9 1
10 SMOKE GYM FLOOR SMOKE —10 1
11 SMOKE GYM FLOOR SMOKE 11 1
12 SMOKE GYM FLOOR SMOKE 12 1
13 ' SMOKE GYM FLOOR SMOKE 13 1
14 SMOKE GYM FLOOR SMOKE 14 1
15 SMOKE GYM FLOOR SMOKE 15 1
16 SMOKE GYM FLOOR SMOKE 16 1
17 SMOKE GYM FLOOR SMOKE 17 1
18 SMOKE GYM FLOOR SMOKE 18 1
19 SMOKE GYM FLOOR SMOKE 19 1
20 SMOKE GYM FLOOR SMOKE 20 1
21 SMOKE GYM FLOOR SMOKE ' 21 1
22 DUCT SMOKE GYM A.C. DUCT SMOKE 22 3
23 SMOKE GYM FLOOR SMOKE 23 1
24 SMOKE GYM FLOOR SMOKE 24 1
25 SMOKE GYM FLOOR SMOKE 25 1
26 PULL STATION GYM WEST EXIT PULL • 26 1
27 SMOKE GYM OFFICE 27 1
28 HEAT 194 GYM OFFICE A`1 YFld, " 28 1
_ 29 SMOKE GYM FOYER STORAGE 29 1
30 PULL STATION_ GYM FOYER PULL 30 1
31 SMOKE GYM FOYER 31 1
32 SMOKE GYM KITCHEN STORAGE 32 1
33 SMOKE GYM UTILITY 33 1
34 SMOKE FIRE PANEL SMOKE 34 1
35 ANSUL GYM KITCHEN ANSUL 35 1
36 SMOKE GYM KITCHEN WEST 36 1_
37 RELAY MOD GYM ROLL UP DOOR RLY 37 2
• S:1Zone Lists\Master Zone Lists\Fire Alarm Zone List
Fire Alarm Zone List Pg Z of-
Name: BANGOR UNION SCHOOL ' . s. , }; :Acct Number:
•
Address: Install Date:
Techs:
City: Premise Phone#:
Primary Panel Phone #:
Signals Sent? Y / N Online? Y / N Secondary Panel Phone#:
Panel Type: Location
Breaker Number& Location:
Annunciator Type: Location:
Inspectors Test Valve Location:
Rpt Device Device Device Soft Zone/
Zone# Type Location Address Information
38 PULL STAITION GYM EAST EXIT PULL 38 1
39 SMOKE GYM KITCHEN EAST 39 1
40 HEAT 194 GYM KITCHEN ATTIC 40 1
41 PULL STAITION GYM KITCHEN EXIT PULL 41 1
42 SUPERVISERY FIRE PUMP FUEL LEAK 42 1
43 WATERFLOW PUMP HOUSE WATERFLOW 43 1
44 SUPERVISERY PUMP VALVE TAMPER 44 44 1
45 SUPERVISERY PUMP VALVE TAMPER 45 45 1
�46 SUPERVISERY PUMP VALVE TAMPER 46 46 1
47 SUPERVISERY PUMP VALVE TAMPER 47 47 1 _
48 SUPERVISERY PUMP VALVE TAMPER 48 48 1
49 FIRE FIRE PUMP RUNNING 49 1
50 SUPERVISERY FIRE PUMP TROUBLE 50 1
51 SUPERVISERY FIRE PUMP MIS SET 51 1
52 WATER FLOW GYM WATERFLOW 52 1
53 SUPERVISERY GYM RISER TAMPER 53 1
54 RELAY MOD GYM SOUTH DAMPER RLY 54 2
55 RELAY MOD GYM RESTROOM DAMPER RLY 55 2
56 SUPERVISERY GYM P.S.NO AC POWER 56 1
57 SUPERVISERY GYM P.S. LOW BATTERY 57 1
58 HEAT 194 GYM P.S. ATTIC HEAT 58 1
59 SUPERVISERY FIRE PUMP LOW FUEL 59 1
60 RELAY MOD GYM A.C. SHUT DOWN RLY 60 3
61 SMOKE GYM ANTEROOM 61 1
62 HEAT 194 GYM RESTROOMS ATTIC 62 1
34:001 NAC NAC 1 MAIN CAMPOS ON CPU#1 1
34:002 NAC NAC 2 PORTABLES ON CPU#2 1
34:003 NAC NAC 3 GYM ON CPU#3 1
S:\Zone Lists\Master Zone Lists\Fire Alarm Zone List
-t et-Pipe California COI of Regulations Title i$ Quarterly-and 2 of 3
r-ire Sprinkler System •Inspection,Testing,and Maintenance Annual Report
Property Information
,��pF C A
tdocsot Contractor or Licensed Owner Information
CiiT �9V
Building Name Bangor Elementary School C� ) Name Voltage Specialists
Address 9%\ P ! Job#1-375
City Bangor ARE MPQ`
r�
ANNUAL INSPECTION,TESTING,AND MAINTENANCE
,Include,ALL Quarterly inspections __ _ ..,,
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
NFPA 25 CA ed.
Item Description Date • .Comments Only ' P,F,NtA:.
Reference
1.19 I Sprinklers 5.2.1 4/28/21
1.20 I Buildings(Freeze Protection) 4.1.1.1 Owner's Responsibility
1.21 I Pipe and Fittings 5.2.2 4/28/21
1.22 I Hangers 5.2.3 4/28/21
1.23 I Seismic Braces 5.2.3 4/28/21
2.1 T Field Service Test Required 5.3.1 4/28/21 If REQUIRED, Enter'F'until
(Send Report to Fire Code Official) results are returned from Lab
2.2 T Recalled Sprinklers Title 19 4/28/21
If not present=Pass: If present=Fail 904.1(c)
2.3 T Water Flow Alarm Devices 5.3.3 4/28/21 48 sec. P
90 sec.maximum - (Enter Time) 13.2.6
2.4 T Main Drain Test 13.2.5 4/28/21
(Enter data on Page 1 of this form) 13.3.3.4
2.5 T Control Valve-Position 13.3.3.2 4/28/21
2.6 T Control Valve-Operation 13.3.3.1 4/28/21
2.7 T Supervisory Devices 13.3.3.5 4/28/21
2.8 T Backflow Preventer Assemblies 13.6.2 N/A
2.9 T Small Hose Connections* 13.5.2.3 N/A
w/PRV Hose Valves-Partial Flow Test 13.5.3.3
2.10 T PRV-Fire Sprinkler Systems 13.5.1.3 N/A
3.1 M Control Valves 13.3.4 4/28/21
3.2 M Small Hose Connections* 13.5.6.3 N/A
Obstruction Investigation required e Yes
3.3 M (If"Yes"see Deficiencies and Comments Section 14.3 4/28/21 No P
for Results.) —
3.4 M System Returned to Service 4.5.3 Nos P
L.`Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III
standpipe systems.
D=Deficiency C=Comment (Indicate type)
"�!@m Date R.- -r �D '" Deficiencies and Comments - ' • •'
:::, : ,Indicate.all e•u•men!'.•vices'and.arts'that were re•aired or re laced
I p
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Form AES 2.1 Sept.3.2013
Wet Pipe California Code of Regulations Title 0 ,i Quarterly and x
Mire ki0lerw5ystem_.:_: __,. � : lnspectton,Testing,=andfVlamteniance _L Annual Repflrt _,:t _,4 ? r
Property Information ,�-(c%F"cqoAt Contractor or Licensed Owner Information
51
Building Name Bangor Elementary School C . jD Name Voltage Specialists
Address 7549 Oro Bangor Highway 9`,, Q, Address PO Box 828
MARE MPp City Oroville St. CA Zip 95965
City Bangor License# 880862 Phone 530-362-2609
Contact Person El SFM Job#I-375
Danny Q CSLB Misc.
Riser Information ` r,
Main Drain Test?(Annual),_
Riser ,; ..,Riser Main;Drain ;inrtrat Static ,Resi i I '.Fi ai Static P,F,N/A £;
Locatwn `:
No. Diarneter'd. . Diameter , Pressure :pressure . ?resure' ;s_ ,;
1 Gym 3 inch 1 1/4 inch 95 90 95 P
2 Pump house 1 inch 1 inch 95 90 95 P
El This building has more than 5 risers. See additional AES 2.9 form attached Number of AES 2.9 forms attached
0 . li- w QUart'erl It1S.eCfio11S . ....' :. ., .. . ".._. , , . . `.
I =Inspection T=Test M=Maintenance P=Pass F=Fait N/A=Not Applicable
a '''61 -&rrnt ..•tia+id'.tirrt V , -, �. i W.,, f x rY 41 :bate 4"".ht1 _ i Co
11; m � '� u ,,. � r NFPA•25;CA ed. Date"`��+�.�' Date. Date
r Descrrptwp , r ,t, R
r � ,�� ,..__��.._... 4 ,�,..� _... .... . .,._�> .,._. , Reference i•-04/28/21.�i��;r.��-erx.��� ���„.<., y,�:�.x�. �,. . -
1.1 I Control Valves—Identification Sign 13.3.1 P
1.2 I Control Valves—Inspection 13.3.2 P
1.3 I Waterflow Alarm Devices 5.2.5 P
1.4 I Supervisory Devices 5.2.5 P
1.5 I Gauges(Wet Pipe Systems) 5.2.4.1 P
1.6 I Enter Water Supply Pressure Below Riser Check 5.2.4.1 psi psi psi psi
1.7 I Enter Water Supply Pressure Above Riser Check 5.2.4.1 psi psi psi psi
1.8 I Pressure Readings Acceptable 5.2.4.1 P
1.9 I Hydraulic Design Information Sign 5.2.6 P
(for hydraulically designed systems)
1.10 I General Information Sign 5.2.8 P
(not required for system prior to 2007 edition of NFPA 13)
1.11 I Heat Tape 5.2.7 N/A
1.12 I Spare Sprinklers 5.2.1.4 P
1.13 I Fire Department Connections 13.7 P
1.14 I Alarm Valves—Exterior Inspection 13.4.1 P
1.15 I Pressure Reducing Valves 13.5.1.1 N/A
1.16 I Backflow Preventers 13.6.1 N/A
1.17 I Small Hose Connections-Hose Valve" 5.1.6, 13.5.2 N/A
13.5.5.1
1.18 I PRV—Fire Sprinkler Systems 13.5.1.1 N/A
"Small hose connections are hose valves and optional hose supplied by the fire sprinkler system. They do not include Class I, II, or III
standpipe systems.
Form AES 2.1 Sept.3.2013
Emergency Drills Bangor Union Elementary 2021-22
Reg Fire Recess Security Recess Earth Security Initial
Date Time drill Fire drill Lock Down Lock Down Quake Weather Other complete
Aug 25-Aug CVA
ASES
Sept 17-Sep CVA
ASES
Oct 21-Oct 21-Oct -�
ASES
Nov 30-Nov CVA
ASES
12/10/21 (? /
Dec soft CVA
ASES
Jan 14-Jan
ASES 14-Jan
Feb 2-Feb
ASES
Mar 22-Mar
ASES
Apr 25-AprAe
ASES
5/25/2022
May soft CVA
J HAYD EN PLEASE PAY FROM THIS
1*-- FIRE PROTECTION INVOICE
2515 Zanella Way#5 Chico, CA 95928 Clllco 530-873.6883 88963
CONCORD 925-246-5033
Contractors License # C16 - 827131 MODESTO 209-568-4765
TOLL FREE 800-417-0440 SACRAMENTO 916-A73-2400
SAN FRANCISCO 415.685.4880
Location c Date }}l Service Type Technician
Address - Next SKvice PO# WO#
CLi4
C/ 1' {fi r'1
City/State/Zip Telephone
`
SERVICE & LABOR BILL TO
•,>f{,irao v c �<2tx 4t :a !a4 1 aver Location
Q Uantlt� o SC O v °� ? 4 Cady' Q
•
AUTOMATIC FIRE SYSTEM SERVICE-6 MONTH SERVICE (7 c.ors Address
FIRE SPRINKLER-QUARTERLY/6 MONTH/ANNUAL INSPECTION
City/State/Zip
FIRE EXTINGUISHER-ANNUAL INSPECTION
FIRE EXTINGUISHER-ANNUAL INSPECTION COMMENTS
FIRE EXTINGUISHER-ANNUAL INSPECTION
6-YEAR MAINTENANCE
HYDROSTATIC TEST
PARTS & MATERIALS
FUSELINKS O 'r.,•:> Ge
NOZZLE CAPS' 1.1• o 2 2
PRESSURIZED CARTRIDGE
1,,
> 4•it`t I i
SUBTOTAL
SALES LAX" •
- " �
• , ice
-TTAL B. LLANCE.L1UE cet—
O, ,
ALL REPLACED PARTS WILL BE RETURNED UPON YOUR REQUEST.
NOTICE: The buyer acknowledges,and by signing this.invoice,is giving written permission that one or more of the fire extinguishers,automatic fire systems,or other five safety devices listed on the invoice
may have been recharged or serviced in excess of(30)days before the due date for one of the following reasons: Previous workmanship was faulty;the unit was discharged;or the convenience of the Buyer.
(0) SERVICE WORK AT THIS LOCATION HAS BEEN PERFORMED MORE THAN 30 DAYS PRIOR TO THE DUE DATE.
FIRE EXTINGUISHER ANNUAL EXCHANGE SERVICE: I am authorizing Hayden Fire Protection to exchange my fire extingiusher(s)with another pre-serviced and or inspected fire extinguisher(s)of equal or
greater fire rating and capacity. It is understood that the supplied fire extinguisher(s)will continue to be within the required service and hydrostatic testing requirements for a period of one year from the date of
this invoice.
TERMS: Payment due upon receipt.
LATE FEE:If we do not receive lull payment of this invoice by 30 days from the invoice date,you must pay a late fee. The late fee will appear on your next statement. We compute the late fee based on a
periodic rate of 1.75%per month,which is an ANNUAL PERCENTAGE RATE OF 21%.with a minimum late fee of 55.00.
RETURNED CHECKS: Returned checks will be subject to a NSF charge of$25.00 and are legally pursued under the California civil code sec.1719(a). By presenting a check for payment and signing this
invoice,you are hereby guaranteeing payment for this invoice. In the event that the check is returned for non suffi cient funds,you hereby give us permission to use any reasonable avenue to collect such
funds,including but not limited to: resubmitting the check with NSF fee,converting the check to multiple smaller ACH transactions until the full amount is cleared,submitting the check to a collection agency,or
possible legal action. • .% ' 7
Signature: X :r'.% _�Y � �- - '71 Payment Method:
V t- ✓✓ '1'.a, \_. ; 9+ `!:�rsxtMf- t-ti. :.�'n;a/l`i'!'" .•T1 1.; ..;. 3
4;, $ItGh0.ica4�p a r �in ere ,� aljformal.p pofRegula. oas 1 fie: 9 ,� N Semi nr
r f. ..b:■:off, "`5..»,_r.¢•.: .,.r-r:.;c �� - ,•.�...,�.,, K 'l,s..�[:�.tJ � .sr �;2 '4_ .�, """'^.�ot fr •
'Yi h"•3 re.�Jl\I N��7��n � Ste T^1.Y l J.4 L may.�/i' f � '� :..J''Jv.t ``- 4�s S l��74
-_: �....�r�...��•- 9 .Y,. �,- ., f�� �� lnspeCtidn��Tes�t�gta�td�Sliainten;�ce �.
..<._... ..:r .n..,o,... ::'�,..:;. r...�.Y,.4';2•,...,.�..:+. �•_r.<.:rvu sdv.....:...s...-..<......�.mot._arts- r,.:-brn,� ..>..rrn+,,..5 ,.u.?' .1:�.?a. � _,:i...:.. �. '�%.,r33 _,.>s,:•
Property Information � �� t Contractor or Licensed Owner Information
Building Name , ., t, , r ,,. . , �;: u),(C jD Name HAYDEN FIRE PROTECTION
Address ') I' {,•/•, i,. : 9� •/? Job li
City i :th.i • ARE MN
o .�;t r> �2.�.5;`••..:;a;e .l r: �t f- v, a sY:!N y x J,ey,)id k�`fi a-k`7'.a.Jr .4 'n > S t +
I
f i{ ,/ j,.+r:Y,t < !<A { 1 nt Cy . r)t C... 7 f'� r .1 li•"+r; n 4'DI �., ..ra l;..n �,£'S'7a� fir! r Z f7 .N c/.: .7
r �-�N � S i r `; � C 1 opt;'.: � ,, �,�ns�iiectlon,-Testi�ig al�clf;Niain�ett�n �•�' � �$ x �'�< ` � <,, s r t
E^A ._..._............. ..�. �..�.�.. •c���::Sa,^�.xa�s...°�,��\h.a�.-..t.w�.....,.:.•...:.,��.....�F.,.n'':•`x,.''1v:.73_ it�7'L.::,.:x_...�w•',..i'4'ix<l.._ _ ..__..t F_,....,y.._c..i..._ ;! _t y;'
= Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
t,..: • z NFPA17ACA •:1: . `f \M
Item DescriptionDate. Comments Only 3 :P,FN/A=
-,.ed.-Reference
2.2 T Fuel Shut-off Operated Correctly 7.3.3.4 L-f
f
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 Er , i{ A,(rt
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4
(if applicable)
3.1 M All Agent Containers within Acceptable Hydrostatic 7 5 1 1
Test Dates ( ) 1 t
3.2 M All Auxiliary Pressure Containers and/or Hose 7.5.1(2)(3) ?
1.4
Assemblies within Acceptable Hydrostatic Test Dates
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2) ; . ;; i i 76 1 1'
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2)
(Non-pressurized)
3.5 M No Si(Non-pressurized)nsofCorrosion in Agent Cylinder 7.3.3.1(2)
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) 4.,. i; it
3.7 M Nozzles are Correct, Clean& Properly Aimed 7.3.3.1(2) 7
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3•4 2 If, 11 ()
3.9 M Fixed-Temp(other than fusible metal alloy type) 7.3.5 1 �? '/!
&Heat Detectors Maintained or Replaced /V 14 •
3.10 M Auxiliary Equipment Such as Water valves 7.3.3.1(2) ?•e ;r,
1,4
Functioned Correctly
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904.7 7_ ii A IA
D=Deficiency C=Comment (Indicate type) •
Item t f Date w Riser r D Defrcrencres,a d Comments !
• , .Indicate,all'equipment,devices and parts that were repaired or replaced•. i
2-t6-1i 1. cri- rA -a A1,E/! .a ‹.ttiofed ..narMI
t
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Check here if additional Deficiencies and Comments are listed on Form AES9 Number attached:
Li 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
Signature Date 7 -i,' i ;
'. ' r,H..y{: ? r- `i •.4'"6 2 r t. rb,. :� ti's.: t. .: -�.?�`�7,0 4:-
et 91,01111 > Pr Engin tired., s �� Ifomia-Ct�doo• egotations Tifle la• r " s =Semi Anlr��uai _ >£
M�1= k �; ins o 'testis an$Maintenance �, , , Y i it l ° ti: •';� ire . ,...shin ys em ► ,
• .e. _.......u.-._.» r»«.:t......u.,n„ .z,,.rs,= ..n.-,a._ , .r�.+.. ••..a.t.- r a '/ ... r.�f'L'>�, r r..�},
Of Cq /�Zl
,�Property Information c -' 'gyp , Contractor or Licensed Owner Information
Tr
Building Namej ,•,.,_„, „,, .,. �:t.,,=,,,._.i ,,; „ 1 1 Name HAYDEN FIRE PROTECTION
Address -�,•.,,.,, • x; r,,. :. , i,�,,• .N jZP Address 7anella Way #5
ARE MP City Chico St. CA Zip95928
City e,,.,., ,,, License# r_�•;-•l 1;j Phone 1-800-417-0440
Contact Person ;:., ❑ SFM Job#
Phone ,4'-j , �L,:C- IN CSLB Misc.
r ,, i� �c it Y.�..4 c .f r.y> f. ♦ .r t .i y n ii r a u U t Sv r 5 4� f
A .\'h;,r,.4� �c•14,:'�f4,L<. ?. °.,5' ; t�7.ct, 4*-fic,I :i,{.., �, , ,�r- Systemltlfo.,,-,,ion ',iJ r is 1 rY tt c L;;C Gt .3 ; 't s �• s 'r.
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,:%f ,. ..y r v'�.-.#;�.<a ., fz . : ,.tr_+.� S`'' ... .. +�> . , .;;F7-r f U.:-:+� .r4s,.., :k .-"�,Y,�`"G'c/G 4cr•.09',2:;`
Cylinder Size 7 i. Last Hydrostatic Test Date 7, II Flow Points Capacity Used
System Location !'•,, i... „ System Mfr. /1,,;,,1 Model# 4'-r•.,.'
Fuel/Heat Shut Off:
Gas# t Electrical# Integral Make Up Air Shut Down
, s , `�,,:-' < - i " :J Nozzle, 1,r,a +Nozzle wn ' c Nozzle ' '. Total,,`
Items ,,f #of Items Dimensions'` Flo 'Qty F.,, P
.i . , . ..,,Mode(;# w.P.oints. ..:;. owP Dints
Hoods 1 CI wtr'
Plenums I <, i� I•ti t i
Ducts I t <!`i " ?.t•/ 1. I '?.
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
r , � ppllance•Name F Nozzle- r Nozzle fiofal V. x f = Nozzle .Nozze Tooaa•[ .,
�.;. Model-. Flow Points flow points , �.' Appliance Name ti r,4'r • is
•..,. >�, : •. :�„ .�.> ,. ,. . ;:..Model, .. :Flow Points• F(ow<Pom s
K1 It, j1 It' ;
Fixed Temperature Sensing Elements •
(such as Fusible Links)
�e� �" ^ "r .Sii2t '�Y d• . �... h.i ��r .`GAv, � 0.4 Y" L s. � ,a r v •.•,ya '
3s�r ' •, .n � �4 y�'.°I 'ita a cl` a.� 0 KS ,i:PWsi t 14�, ag 4 P ¢ alt-i
QGId r S4 FA i ;. Ate. s._"K,c_`t.,_. _ +� ��?t l V1d r V e,tC1,�„!?43 4 'sa AO ', P. .E ?,�i G*
s.3s si. a :: nu a t@ 2_ > war t. n 'Sf ��S R46«t SL .. uix Y x .rF a. 3. e 8 t«.�
.. lit,‘ .7C14 2 - it- (I
Inspection Testing and Maintenance
.
1 =Inspection T =Test M=Maintenance
p P=Pass F=Fail N/A=Not Applicable pv
, � - •• Desc ipi oti � �' 1�VtlEI_ t7A�Gd ale k �ts,On)" IA:
• ?s-• , - 1 -v-•m ;,:? ,s in -��^+/ � ..,. r��1'O.t1�; efE:re fi`N't s` C, ".§M , 45g+A-..X .a, A9
Manual Actuators are Unobstructed
1.1 I w�_Il- di 7.2.2(2)
(i.e.remote pull station) f
1.2 I Tamper Indicators&Seals Intact 7.2.2(3) 7.IG.71 e
1.3 I Maintenance Tag in Place 7.2.2(4) ?-It 1'
Titllee19§906 l ,
1.4 I No Obvious Physical Damage 7.2.2(5) 7 i(,.-I;
1.5 I Gauge Readings within Proper Limits O 7 2 2 6 y i ;r
(Stored pressure) c A. tt r
1.6 I Blow-off Caps in Place&Undamaged 7.2.2(7) G ry -i i yJ
,
1.7 I Hoods,Ducts,Filters in Place and Clean CFC 904.11.6.3 a st,••;' f'
1 8 I Hood, Ducts&Protected Cooking Appliances Have 7 2 2(8) :'
Not Been Replaced.Modified or Relocated If
2 1 T Automatic Detection/Manual Actuation Functioned 7,3.3.4 ,;
Correctly —