HomeMy WebLinkAboutFAI21-0007 010-170-001 CF Hood 2022 i 2/ — 0007 0(0 —(7C--o6 j
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 .;trGr.'"---1 it Contractor or Licensed Owner Information
'BuildingName Memorial Hall ; i 4) Name Wilgus Fire Control Inc.
'Address 249 Sycamore St. �t1' ., _�. Pi Address 4544 Mountain Lakes Blvd.
' hc- ve
��• MP> City Redding St. CA Zip 96003
'City GRIDLEY (License# 462979 (Phone (530) 241-2465
'Contact Person I 0 SFM 'Job# 2221050322
'Phone 538-7407 I ❑X CSLB "Misc.
System Information
Cylinder Size 3 gal Last Hydrostatic Test Date 2013 Flow Points Capacity Used 8
System Location Right of hood System Mfr. Ansul Model# R102
Fuel/Heat Shut Off:
Gas# Yes Electrical# Integral Make Up Air Shut Down
r, Nozzle I� Total
Items #�f #oms �F . . ,
•cants Qty Flow Potnts.
Hoods 1 8' I
Plenums I 1 I 8' I 1N I 1 I 1 I 1
Ducts I 1 I 13"x12" I 2W I 2 I 1 I 2
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Nozzle Nozzle Total Nozzle I Nozzle I Total
Appliance Name Model Flow Points Flow Points Appliance Name Model Flow Points Flow Points
Griddle 260 2 2 I I I I
6 Burner Range 1F I 1 3 I I I I I
I I II I I I
I I I I I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
1 1 - Mfr ' 4 Install
�t , ..3 Quantity Temp
' ) Date :� Date
3 360 2022 05/03/2022
I�I I I
I I I I
Inspection, Testing,and Maintenance
Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
„,fwr o- -,,,,,,, --- ,-..,,,,, , -- ----:,,, , • , , , , ' - r— r,....,,r,„ ,
,2x ..an ...,.
1.1 I Manual Actuators are Unobstructed I 7 2 2(2) 5/3/2022 I P
(i.e. Remote Pull Station)
1.2 I Tamper Indicators&Seals Intact I 7 2 2(3) 5/3/2022 I I P
1.3 ( I Maintenance Tag in Place I 7.2.2(4) 5/3/2022 P
Title 19&906
1.4 I No Obvious Physical Damage I 7 2 2(5) 5/3/2022 I I P
1.5 I Gauge Readings within Proper Limits 7 2 2 6 5/3/2022
(Stored Pressure) ( ) I N/A
1.6 I Blow-Off Caps in Place&Undamaged 7 2 2(7) 5/3/2022 I I P
1.7 I Hoods, Ducts,Filters in Place and Clean CFC 904.11.6.3 I 5/3/2022 I I P
1 8 I Hood, Ducts&Protected Cooking Appliances Have 5/3/2022
Not Been Replaced,Modified or Relocated 7.2.2(8) P
2.1 T 'Automatic Detection/Manual Actuation Functioned 7.3.3.4 5/3/2022 P
(CorrectlyI
Form AES 20
Sept.3,2013
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 .:,t4aF Ca���D' 1 Contractor or Licensed Owner Information
(Building Name Memorial Hall i )5 S Name Wilgus Fire Control Inc.
(Address 249 Sycamore St. �
� �� r Qom' Job# 2221050322
a� SAE MP.f`
(City GRIDLEY ��� .�—
Inspection, Testing,and Maintenance
=Inspection T =Test M=Maintenance P=Pass F=Fail
, N/A =Not Applicable
% .� 4 �.. 4, .' ,'' !I ? i ,die,,, e a x„% e A:? f .•t, o o- ,,{.
Ite •mE
5/3/2022
2.2 T Fuel Shut-Off Operated Correctly 7.3.3.4 P
5/3/2022
2.3 I T Regulator Tested&is within Acceptable Limits 7.3.3.4 N/A
2.4 I T Manual Reset Relay Functioned Correctly 7.3.3.4 5/3/2022 I N/A
(If Applicable)
3.1 I M All Agent Containers within Acceptable Hydrostatic 7 5 1(1) 5/3/2022 I P
Test Dates
3.2 III Auxiliary Pressure Containers and/or Hose 7 ( )( )5 1 2 3 5/3/2022 I N/A
M 'Assemblies within Acceptable Hydrostatic Test Dates
5/3/2022 I 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) 5/3/2022 I P
(Non-pressurized)
3.5 I M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2) 5/3/2022 I P
(Non-pressurized)
5/3/2022
3.6 I M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) P
5/3/2022
3.7 I M Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) P
Fixed TempFusible Metal AlloyType Detectors Replaced 5/3/2022 I P
3.8 I M YP P 7.3.4
3 9 I M Fixed-Temp(Other Than Fusible Metal Alloy Type)& 7 3 5 5/3/2022 I N/A
Heat Detectors Maintained or Replaced
3.10 I M Auxiliary Equipment Such as Water valves 7.3.3.1(2) 5/3/2022 I N/A
Functioned Correctly
5/3/2022
3.11 I M Internal Maintenance as Required by Manufacturer Title 19§904.7 N/A
D=Deficient C=Comment Indicate t •e)
Item Date Riser D C Deficiencies and Comments
Indicate all equipment,devices and parts that were repaired or replaced
El Check here if additional Deficiencies and Comments are listed on Form AES g. Number attached:
El 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 Richard Hughes
ISignature I ff,.-k j Date 5/3/2022
Form AES 20 Sept.3,2013