HomeMy WebLinkAboutFAI18-0012 065-110-058 CF Hood 4.2022 4if8 - oa ' z_ 0 6c— Zia --o cg
'Met Chemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual -114 '
..,,,,Fire Ext!nguishing System inspection,Testing,and Maintenance Report . ,.
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Property Information i,��•. `:°otf Contractor or Licensed Owner Information
Itf Wilgus FireControl Inc.
'Building Name-g ,L (L,C.t1; .c;Rye_ C.. a .0- , ) % 'Name 9
1
I ��Address p`. w,...>1n Tr Address 4544 Mountain Lakes Blvd.
2t 'tvi- -tJ �
t1t�RE Mf� (City Redding St. CA Zip 96003
'City tNV).40-t.Z c. 'License# 462979 ,Phone 530-241-2465
'Contact Person -e,,s5,2.-r1..-- I ❑ SFM (Job# `5 .a ,( 3
'Phone g' ' et e i 3 rj q"?7 ( [Z,j CSLB (Misc.
t .t 1 1 ii :sue
,
r-.. Systom I . . . - -
--_ L— Model# i - t;ci ;
Cylinder Size 4 ���n k ',��,,. Last Hydrostatic Test Date � I �, Flow Points Capacity Used t 5
System Location ,t System Mir. 1.� i '� ..-..-
Fuel/Heat Shut.Aff:
Gas# r Electncal# /' Integral Make Up Air Shut Down .'
t . x ' i @ � � 1flTotal
Items #.gllte►t1s: ai, A�rpe S �js � , LL F t ,,: - �g ,0 Flow Points
II Y
t �x
F . >,., -, ,.. . ..
'Hoods I ' .. I (/ r 4 I I
Plenums
I 2. Igra I ttJ I 1 I I -
'Ducts I 2 I iq// _k tZ" I L t1J I It I 2 I Z-
Cooking Appliances
Left to Rioht with Sizes and Coverage Nozzles
Appliance. ce Name • Noriie• Npzzie `" t l• ilanee Name „'" , ,,, Nozzle Total
PR n • -Model Flo+✓Points FI yi oints� - DPP Mel " ' Flow Points Flow Points
t tom, ci dt 42. •ZC 0 Via_ ?..- I I I I
tz0 t,1L- (L..-� I t t-..i I I I t I F I
-C-F.,....*ii e....0- -7-q la
-2- � . 7, I4 I
I-' LLD-n L..(.- I t 1.5 I ( I -2.. I I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links) ___
fylir 1f8 I}lif% 1 1 Install
Quantity Te Dafe i
Y I mp • I �� � :Qt�anttl� I� Tetrtp � 0"ate � Date
I I I - 2 I I I I I
Inspection,Testing,and Maintenance
1 =Inspection T =Test M=Maintenance P=Pass F=Fait N/A =Not Applicable
Item ,D0,,, pIion e - Gorinipettts Only P4,4
pe � -• IA
1.1 I 'Manual Actuators are Unobstructed 2 2(2) I
(i.e, Remote Pull Stations
, 1.2 I 'Tamper Indicators&Seals Intact I 7.2.2(3) I 1 I T w�
1.3 I (Maintenance Tag in Place I Title 19$906 I I ( _..__., t
1.4 I INo Obvious Physical Damage I 7,2.2(5) I I I t-'
1 5 I (Gauge Readings within Proper Limits l 7.2.2(6) _ __. c�(A'
(Stored Pressure) _ ((�~�
1.6 ( I IBlovr-Off Caps in Place&Undamaged 7.2.2(7) 1
t"
1,7 I 'Hoods,Ducts,Filters in Place and Clean I CFC 904.11.6.3 1 I
1 8 I 'Hood,Ducts& Protected Cooking Appliances Have I 7 2 2(8) 11 e
Not Been Replaced,Modified or Relocated _._.. _
2 1 T 1utomatic Detection/Manual Actuation Functioned
I 7.3.3.4 I I 1 '
Correctly
lone - ,
r...v. n CC.'In
'ro e e Ica ' 1 l' '': "i.a :, I,' it ' III �.�. � t l � �� 1 '�I : �,y-i�li Ili, �,Ul'�r
Bhing System Inspection,Testing,and Maintenance Report ,x
1121,11
Property Information Contractor or Licensed Owner Information
Zil
'Building Nam A-H-L, Co , ci i` t-o_ .4( ° F. Name Wilgus Fire Control inc
Address 1{t i � + .2 �-� tivi\� fob# tk ti. I
ili--Mir-
City VN�CG�t..Li'a.. 1k'
inspection,Testing,and Maintenance
1 =Inspection T =Test M=Maintenance P=Pass F=Fall N/A=Not Applicable
Item 1 vI F ., #. mI w'. ._Cotnments;Only P,F,N/A
, M� - `�
2.2 T Fuel Shut Off Operated Correctly I 7,3.3,4 fli"
2.3 T 'Regulator Tested&is within Acceptable Limits I 7.3.3.4 I P
t
2' 1!Manual Reset Relay Fyn&/onesi Carr ctly_ _-_ }�^��
(If Applicable) 1 7.3.3.4I 1 1" i
IAII Agent Containers within Acceptable Hydrostatic I \ I
3.1 tit 7 5.1(1)
Test Dates
AIl AuxiliaryPressure Containers and/or Hose
3.2 M }Assemblies within Acceptable Hydrostatic Test Dates I 7.5.1(2)(3) I \ I
I3.3 M !Cartridge Weights within Acceptable Limits I 7.3,3.1(2) \ I I p
3.4M
Liquid Level within Acceptable Limits f
I (Non-pressurized) ( 7.3.3.1(2) I I I I tf
3.5 M No Signs of Corrosion in Agent Cylinder I 7.3,3,1(2) ,!"1
(Non-pressurized) 1 '
3.6 M Distribution Piping Unobstructed and Contiguous I 7.3.3.1(3) I I !D !
3,7 M 'Nozzles are Correct,Clean& Properly Aimed I 7.3.3.1(2) , I IP
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced! 7.3.4 \ Q
a Fixed-Temp(Other Than Fusible Metal Alloy Type)& I t 3(4
3.9 M 7.3.5
N Heat Detectors Maintained or Replaced
Auxiliary Equipment Such as Water valves
3.10 M I 7.3.3.1(2) .
Functioned Correctly U
3.11 M Internal Maintenance as Required by Manufacturer I Title 19 r;904.7
D= Deficiency C=Comment (Indicate type)
`�' Deficiencies and Comments,� r s�,�° leaf 0 C
I t f p .
•� ,.� ._ trtti;cate a;(.or equipment,nneir,devr�s artd arts flip/�-errz r>3 afredgfre to ari
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Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
I See Correction Form AES 1d 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 AN M.I.).C'.,.1 E E..0-- -
Signature p.,,r'{ Date , .--1 "` 2.7 I
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