HomeMy WebLinkAboutFAI22-0002 CF Hood Suppression Inspection June 2022 ay
Fire Extin uishing System Inspection,Testing,and Maintenance Report a
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Property o �.,p% Contractor or Licensed Owner Information
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Pro a Information �c,"
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'Building Name EA, l of li* L';4t•C aii.6. j,Dv 'Name Wilgus Fire Control Inc.
'Address 2 ,I-, A��/T� ():, STe, vy��\,C'___,.y�4'7 {Address 4544 Mountain Lakes Blvd.
I 1ItAE MpP (City Redding St. CA Zip 96003
'CRY 0 r\o, /ll. 'License# 462979 'Phone 530-241-2465
'Contact Person 62ta,, C lir. cr1-Ly I E SFM {Job#
'Phone '7/2 f ''/(p 5"37 — 97(a/ 10 CSLB !Misc.
31 4 System Information , . -
Cylinder Size `-3 e, Last Hydrostatic Test Date (I Flow Points Capacity Used i(> _
'System Location )4...) '.G,,4- System Mfr. 4.4J /.61 : Model# /�/ (77
(Fuel/Heat Shut Off: A �'`
'Gas# J Electrical# Integral Make Up Air Shut Down
Items I #of Items I Dimensions I Nozzle I Nozzle INozzle I Total
Model# Flow Points Qty Flow Points
'Hoods I ( I 61/ik( 7 I I I I
'Plenums I I I I 1 N I I I I I /
'Ducts I r I 5t V< I A I 2 (!7 I 1 I I 1 ,/ I
` Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name
Nozzle Nozzle Total
Appliance Name Nozzle Nozzle Total
I Model Flow Points Flow Points ( Model Flow Points I Flow Points
1. eiaYAi. ti I I P' l .� I I I I I
t•r)���/. I i A) I i I 1 I I I I I
l/ti- I -- u) I I - I I I I I
I I I I II
I I I II I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity Temp Mfr Install Quantity Temp Mfr Install
' Date Date Date Date
'7 15 6-U I ,', 1 -2 {..{ {
I I I II I I I
r -,.<..x: Inspection,Testing,and Maintenance "<
1 =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item I I Description NFPA 17A CA ed.Reference Date Comments Only I P,F,NIA
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Manual Actuators are Unobstructed
1.1 I 'Manual
Remote Pull Station) 7.2.2(2) 4
1.2 I (Tamper Indicators&Seals Intact 7.2.2(3) f I '
1.3 I 'Maintenance Tag in Place I Title 19( 906 I ✓
1.4 I INo Obvious Physical Damage 7.2.2(5) I I t% ,
1 5 I (Gauge Readings within Proper Limits I 7 2 2(6) I 'Pa
(Stored Pressure)
1.6 I 'Blow-Off Caps in Place&Undamaged 7.2.2(7)
1.7 I (Hoods,Ducts,Filters in Place and Clean ( CFC 904.11.6.3 I I
, g i Have (
1.8 I 'NotHood BeenDucts Replaced.&IProtected ModifiedCookin nr ReApplIor, tpdances 7.2.2 8) I �P
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2.1 T (Automaticorrectly Detection/Manual Actuation Functioned7.3.3.4 I
Form AES 20 Sept.3,2013
= r' N =g e-Engineered California Code of Regulations-Title 19 • Semi-Annual 4
Fire Extinguishing System Inspection,Testing,and Maintenance Report 2 o',„
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Property Information ,,�` f�p Contractor or Licensed Owner Information
(Building Name �er' �j Wilgus(c-- 1
Fire Control Inc.
Address y3. . e Job#
q 1i&E MP
City D term t . a, R'�,--z>
Inspection, Testing, and Maintenanc
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item I I Description A CA
ed.Rd.R efe r 1lenc ce Date Comments Only P,F,N/A
e
2.2 I T (Fuel Shut-Off Operated Correctly 7.3.3.4 //
2.3 T (Regulator Tested&is within Acceptable Limits I 7.3.3A I I / /A
2 4 T Manual Reset Relay Functioned Correctly 7.3.3.4 `V//�
I (If Applicable) I I I 1
3.1 M IAll
Test AgentDates Containers within Acceptable Hydrostatic I 7 5.1(1)
r.,
lAII Auxiliary Pressure Containers and/or Hose 7 5 1 2 V
3.2 M Assemblies within Acceptable Hydrostatic Test Dates ( ( )(3) I I
3.3 M (Cartridge Weights within Acceptable Limits I 7.3.3.1(2) I U I
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2) 9
(Non-pressurized) (
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2)
(Non-pressurized) I
3.6 M (Distribution Piping Unobstructed and Contiguous I 7.3.3.1(3) ( I U
3.7 M (Nozzles are Correct,Clean&Properly Aimed I 7.3.3.1(2) I I
3.8 M !Fixed Temp Fusible Metal Alloy Type Detectors Replaced) 7.3.4 I I ar
3.9 m (HFixed-TempeatDetectors(Other ThanMaintained FusibleorRepla Metalced Alloy Type)& I 7.3.5 I I M
3.10 M !Auxiliary Equipment Such as Water valves I 7.3.3.1(2) ( Ai/74
Functioned Correctly b �I
3.11 M 'Internal Maintenance as Required by Manufacturer I Title 19§904.7 r�//'�I I
D=Deficiency C=Comment Indicate •e
Riser D C Cla Citc7es and Comments
, , Indicate all equipment.drwrces and parts that were repaired or replaced -
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❑Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
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 ke t/`-0-2412eii V
Signature I f Date 7—A 5_-2 Z-
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Form AES 20 Sept.3,2013