HomeMy WebLinkAboutFAI15-0001 060-060-012 CF Hood 2022 Camp Lassen Wet Chemical Pre-Engineered California Code of Regulations eTitle 19 Semi-Annual 1 of 2
itewExtinguishing System Inspection,Testing,and Maintenance '` Report ,, .,,
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Property Information f-C.`/ �14 Contractor or Licensed Owner Information
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(Building Name /„�y S,�� � , � ) Name Wilgus Fire Control Inc.
(Address �,/ -"-of 5�d,iti-r—,`�p,� I ',r`,��\ �,, , Address 4544 Mountain Lakes Blvd.
�1 �; E M City Redding St. CA Zip 96003
(City 13ac%7=e__ 7//•ed;,1) S 'License# 462979 'Phone 530-241-2465 J
(Contact Person {G,rif,iv I ❑ SFM I Job#
(Phone 9/6 76 5-3:,,7(f. T7-3 L 6(r/ lizi CSLB IMisc.
m .. . System Information ' ''. ,,.1. ,
Y /7 /-7 Capacity y Lf lT Last Hydrostatic DateFlow Points Ca acit Used
Cylinder Size � 0.- P�
'System Location /(,9--e,A— System Mfr. _4/V'-e(i{, Model# le'/(9Z_
Fuel/Heat Shut Off: , <
Gas# .}/.._ Electrical# Integral Make Up Air Shut Down
Items -'�`#of•at a I I I �,zzle �` ' ;�w Total
t.e, 4.. .4..k, t;lit.�x e,. "s'' :: . . .,Mode ,. . _F ,,Qoi tS ,+e +` L 41 „Qt ,Myra, Flow Points
Hoods I G, IcW72. 5‘4163cr I I I
Plenums I 2 I •1 /u1 I I I i' I ce-
'Ducts I ' Iit7Z/Z JZ a-I 2.UJ I ' i 1 I
` Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name r 11 Modelµ I) .a, SIB I..,. orit ,, , c' & e, ,. ,I0 �'N ode#,;glItFlo ozzle Total
" "� r wPoints Flow Points
-1` C k si e�`� I 5 I -, I Le I I I I I
''l ti.i•A./ I A4& I Z I 7 I I I I I I
G tf e,6v(....c- I / N I 1 I / I I I I I 1
(-- /z),t' 4 I iAl I ( I / I I I I
I ` I I II I I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity I Temp �I ,11Afr ' I I.� , ��' .,1I� a- a.1 m r p r,' .I Iulf ' I Install
r �.�»�a; :.�,„fin .a .�� �' �r ®e �TM,eG"�`�"T4 r �:��.wiiri r �.� �.�a��Uate� .Date
& I ' 40 I �,/ I 27.— II � �I I I
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_ Inspection,Testing,and Maintenance , '
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item I c 17. lD SC DtIon'Vr: ''' 3 €a" ' I :f:�. .. . �r..r. 'Co llrlfien only I P,F,N/A
Manual fete c
1 1 I Actuators are Unobstructed ��� 7 2 2(2)
Remote Pull Station)
1.2 I 'Tamper Indicators&Seals Intact 7.2.2(3) I I I ,e
1.3 I (Maintenance Tag in Place 7.2.2(4) I I I f
Title 19 4906
1.4 I INo Obvious Physical Damage 7.2.2(5) I I I
I ( 7 2 2(6)Gauge Readings within Proper Limits
1.5 �p
1(Stored Pressure) I I /v�i�
1.6 I (Blow-Off Caps in Place&Undamaged 7.2.2(7) I I 4
1.7 I 'Hoods,Ducts,Filters in Place and Clean CFC 904.11.6.3 I I P
1.8 I (Hood, Ducts&Protected Cooking Appliances Have 7 2 2(8) I I '/�
Not Been Replaced.Modified or Relocated /
2 1 T utomatic Detection/Manual Actuation Functioned 7.3.3.4 I I �-J
Correctly
Form AES 20 / '' 1 l o o f 0 c0!-Woo 0 t.Z
Sept.3,2013
'retire Engineered California Code of Regulations-Title 19 Semi-Annual 2 of Z
Firs ulishing System nspection,Testing,and Maintenance Report .s
Property Information .4,4 CA���ol'r Contractor or Licensed Owner Information
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(Building Name 10.14., g s,zti. - 5" Name Wilgus Fire Control Inc.
!Address eV �1 Q CO u ( j v( 't�:`•�P,zPi/ Job#
City ��ac/ /—c_ ,�flw� '�i..M,—
c 5..s Inspection ,.
�d�' �° _ p CtlOn,Testing,and Maintenance � �� �'`���
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item ;ilk kiesc,p`ti`� , o Co m Only P,F,N/A
2.2 T Fuel Shut-Off Operated Correctly 7.3.3.4
Igi
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 A//A
2 4 T Manual Reset Relay Functioned Correctly 7,3.3.4 //�
(If Applicable) 1���
3.1 lvt All Agent Containers within Acceptable Hydrostatic 7,5.1(1) p
Test Dates
3.2 lvt All Auxiliary Pressure Containers and/or Hose 7,5.1(2)(3)
Assemblies within Acceptable Hydrostatic Test Dates
3.3 M Cartridge Weights within Acceptable Limits 7.3.3,1(2) /f
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2) ✓r�
(Non-pressurized)
3.5 I M No Signs of Corrosion in Agent Cylinder 7 3 3 1(2) r(
(Non-pressurized) ,/
3.6 I M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) I
3.7 I Nl Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) I
3.8 I M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 I
I Fixed-Temp(Other Than Fusible Metal Alloy Type)& 1
3'9 M Heat Detectors Maintained or Replaced 7,3.5 /,r
3.10 I M Auxiliary Equipment Such as Water valves 7.3.3.1(2) ,
Functioned Correctly I �
3.11 I M Internal Maintenance as Required by Manufacturer Title 19§904.7 I /
D=Deficiency C=Comment (Indicate type)
''ig Riser D C (& Ill 17NI
III =S - . Oa a S '"7 3,
r Indicate al� i �,: vv g p t.devices and harts that were repaired orreplaped ,_ „�, ,, —;>>,
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I_1 Check here if additional Deficiencies and Comments are listed on Form AES 9. 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 , & ,Ai,vd ( !AGt.G'i9 1
Signature I ' Date c--/Z Zz__ I
vv ,
Form AES 20 Sept.3,2013