HomeMy WebLinkAboutFAI22-0006 010-250-025 CF Hood New Hovlid Kit Hood 10-25-21 Wet Chemical Pre-Engineered California Code of Regulations -Title 19 Semi-Annual 1
Fire Extinguishing System Inspection,Testing,and Maintenance Report
Property Information ;Afc'OF Ca4/',NIF Contractor or Licensed Owner Information
Building Name New Hovlid Community Care Center r 15 Name Voltage Specialists
Address 246 Spruce +f�j --if Address 370 Apple Lane
>> F MR=� City Paradise St. CA Zip 95969
City Gridley License# 880862 Phone (530)624-4514
Contact Person Mike Newton ❑ SFM Job#
Phone701-7687 ❑■ CSLB Misc.
AM System Information
Cylinder Size 3 qal 1 1/2 qal Last Hydrostatic Test Date 2019 Flow Points Capacity Used 7
System Location Wall next to the hood System Mfr. Ansul Model# R102
Fuel/Heat Shut Off:
Gas# Electrical# Integral Make Up Air Shut Down
71
Items #of Items Dimensions o le Nozzle Nozzle Total
Model# Flow Points Qty Flow Points
Hoods 1 10' - - - -
Plenums 1 10' 1 N 1 1 2
Ducts 1 2'x1 2W 2 1 2
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name Nozzle Nozzle Total Appliance Name Nozzle Nozzle Total
Model Flow Points Flow Points Model Flow Points Flow Points
•
Range 1F 1 3
•
Griddle 1 N 1 1
•
Pot 3N 3 6
Fixed Temperature Sensing Elements
(such as Fusible Links)
Quantity Temp Mfr Install Quantity Temp I Mfr I Install
Date Date Date Date
3 450 2021 10/25/21
I
Inspection, Testing and Maintenance W
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Item Description NFPA fer CA Date Comments Only P,F,N/A
ed.Reference
1.1 I Manual Actuators are Unobstructed 7 2 2(2) 10/25/21 P
(i.e. remote pull station)
1.2 I Tamper Indicators&Seals Intact 7.2.2(3) 10/25/21 P
1.3 I Maintenance Tag in Place 7.2.2(4) 10/25/21 P
Title 19§906
1.4 I No Obvious Physical Damage 7.2.2(5) 10/25/21 P
1.5 I Gauge Readings within Proper Limits 7 2 2(6) N/A
(Stored pressure)
1.6 I Blow-off Caps in Place&Undamaged 7.2.2(7) 10/25/21 P
1.7 I Hoods, Ducts, Filters in Place and Clean CFC 904.11.6.3 10/25/21 P
1.8 I Hood, Ducts&Protected Cooking Appliances Have 7 2 2(8) 10/25/21 P
Not Been Replaced, Modified or Relocated
2.1 T Automatic Detection/Manual Actuation Functioned 7.3.3.4 10/25/21 P
Correctly
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
OF G'q��ptit
Property Information :�� 'gyp of Contractor or Licensed Owner Information
foot
Building Name New Hovlid Community Care Center Name Voltage Specialists
','
Address 246 Spruce i Job#
City Gridley ti. E M
Inspection, Testing and Maintenance
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
NFPA 17A CA T Date Comments OnlyP,F,N/A
Item Description ed.Reference
2.2 T Fuel Shut-off Operated Correctly 7.3.3.4 10/25/21 P
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 10/25/21 P
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4 N/A
(if applicable)
3.1 M All Agent Containers within Acceptable Hydrostatic 7.5.1(1) 10/25/21 P
Test Dates
3.2 M All Auxiliary Pressure Containers and/or Hose 7.5.1(2)(3) 10/25/21 P
Assemblies within Acceptable Hydrostatic Test Dates
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2) 10/25/21 P
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2) 10/25/21 P
(Non-pressurized)
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2) 10/25/21 P
(Non-pressurized)
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) 10/25/21 P
3.7 M Nozzles are Correct, Clean&Properly Aimed 7.3.3.1(2) 10/25/21 P
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 10/25/21 P
3.9 M Fixed-Temp(other than fusible metal alloy type) 7.3.5 N/A
&Heat Detectors Maintained or Replaced
3.10 M Auxiliary Equipment Such as Water valves 7.3.3.1(2) N/A
Functioned Correctly _
3.11 M Internal Maintenance as Required by Manufacturer Title 19 §904.7 10/25/21 P
D=Deficiency C=Comment (Indicate type)
Item Deficiencies and Comments
EMMIENI=Pir
Indicate all equipment,devices and parts that were repaired or replaced
rn
I
❑Check here if additional Deficiencies and Comments are listed on Form AES9 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 Randy Rader
Signature Date 10/25/21
Form AES 20 Sept.3,2013