HomeMy WebLinkAboutFAI15-0060 031-260-016 CF Hood Suppression 2020 n .�. ell' ' :� u4- o '� � � foA-1 w i n�i 1 oft
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Property Information „zits/ Contractor or Licensed Owner information
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v Name Wilgus Fire Control Inc.
Building Name 5 1 2..1Z.V.0. S G1nflo \ ` 1
Address 1 O 2;1) i e..(2.444.... ` Q.- o dr Address 1703 Sonoma St.
.�' N1P City Redding St Ca Zip 96001
City`"-A.e.,(1__mc.,-li-k-fl License# 462979 Phone 503-241-2465 -
Contact Person 1 ._e._.,D 0 SFM Job# ' i 1 41 GC
Phone 6-5s IR(O ® CSLB Misc �
F ..t. _. 4 .. LM.,"• `....YJ�`�`�-J .;;:5ystem Information '. ..r `.r..-r-. ' .p• . --,- ._ ., 4 .�^-> a..
_. _ a_ _ Flow Points Capacity Used
Cylinder Size . 4 p� Last Hydrostatic Test Date 7iO ZO p �' 4
System Location Cti l,� System Mfr.ft- 51K•1--- Model# {.._- 1.6 Z
FueUHeat Shut Off Integral Make Up Air Shut Down
Gas# t Electrical#
�- „
7. s r s +, I Nozzle NozzleNozzleIt', Nozzle ---•-1 Total .
Hoods It i LAl
Plenums i 1. I.
Ducts l ( S x (5 l i ) i I k
Cooking Appliances
Left to Ri•ht with Sizes and Coverage Nozzles
7: '1 v: -F ra1� r e `No Ir0- - Appliance Name Nozzle :q%Al : 1 �4 o hts
]rr a.Y r ,i r , n t •.eh' Flow' biiits:; Sa, ''!Vs • pp 'Model -FIoVf',W,I ,. -k. .
ts -
Q-a t.zi-t L Z`1 2 4 S t 1 —I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
InstallDate • M
Quantity •Temp - QuantityTemp„ Date • Date... ,. <
.
•
Lt 5 0 2-z i.C1 j Z' 1 - ?
,v !�- s'f q 1 r• -S Xit a`'. 'PT71 l r-',W, t T�3.1� -
=t .� t,��i"7G� f'F��� ��yfa[ +'3r e t e�•.,.c�"�'. � y t 'a� l7 i'``�ir�,��`
r' y „�, $ .� 0, t b S t s, r n t ai �eret{, r Kt •ni l M,t4 �"�.'�' :
n... ..bf �'� r a tint,,.$."�`��',. :-..^C�-rl.r'�it 7 `+0.-42.+�e'a C.. "tr:'4 :;1r 26�, , ri.` ' „ r ,,,,
'�"�.�ri&??. fi » . ,+�"".'�.�r�a�Mc�t-}' %�•;._ Y7:. i '
I =Inspection T = Test M = Maintenance P=Pass F =rail N/A =Not Applicable
• NFPA.I7A CA . 4.
Item'_ .Description ed.Reference Date Comments Only.- _ P,F NIA
1 1 I Manual Actuators are Unobstructed 7 2 2(2; '7-2/-2v T
21)
(i.e.Remote Pull Station) 1
1.2 I Tamper Indicators&Seals Intact 7 2.2(3) c e
7.2.2(4) P
1.3 I Maintenance Tag in Place Title 19 4906
1.4 I No Obvious Physical Damage 7 2 2(5) e /�
1.5 I Gauge Readings within Proper Limits 7 2 2(6) 1�-'�11
(Stored Pressure) 1 _—
1.6 I Blow Off Caps in Place& Undamaged 7 2 2(7) p
1.7 I Hoods,Ducts, Filters in Place and Clean CFC 904.11.6.3 T
1 8 I Hood,Ducts& Protected Cooking Appliances Have 7 2.2(8) P
Not Been Replaced,Modified or Relocated t
2.1 T Automatic Detection/Manual Actuation Functioned 7 3 3.4 `1( P
Correctly -
Sept.3,2013
Form AES 20
•
till $ � .�! it erla yra .&ns- a 1 r. '_ y�AnA'.nuai4... Up..
1 ,.: • 4•w. r c. . sl_ r .x a jx !ru Y '.a."Report :: xr:k _1�+ s
•
_1F Ca Contractor or Licensed Owner Information
Property Information , \9
it
co% ID Name Wilgus Fire Control Inc.
Building Name 0.0 Q QL cji.„D a 1
Address L O Z 3 S I Q.04_ 9 � P Job# 3 1
City le. -ChCa.l. b 1 E 0'
f s -ri . . 1 L''-'';.7 A •::..,i ng an' Mal tuna.�� ,.4- �1!xd' �4',u r`',s is -
P Pass r = r-a I N/A Not Applicable
I Inspection T Test M MaintenanceNFPA 17A CA .p
, . : ..Date Comments Only; 4 i 'P,N1A
:Item ; ;+ sw e�o[i - o K`i ed.Referen4b'4.
2.2 T Fuel Shut-Off Operated Correctly 7 3 3 4 7 - .t- _
2.3 T Regulator Tested&is within.Acceptable Limits 7.3 3.4 P
Manual Reset Relay Functioned Correctly 7 3.3 4 0
2.4 T (If Applicable)
3 1 M All Agent Containers within Acceptable Hydrostatic 7 5 1(rl —
Test Dates i
3 2 M All Auxiliary Pressure Containers and/or Hose }7 5 1(2)(3) t ��
Assemblies within Acceptable Hydrostatic Test Dates
3.3 M Cartridge Weights within Acceptable Limits 7.3.3 1(2) 2
3.4 M Liquid Level within Acceptable Limits 7 g 3.1(2) P
(Non-pressurized) _
3.5 M No Signs of Corrosion in Agent Cylinder 7 3-3.1(2)
(Non-pressurized)
3.6 M Distribution7 3 3 1(3)Piping Unobstructed and Contiguous
3.7 M Nozzles are Correct,Clean&Properly Aimed 7 3.3.1(2) e
3 8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7 3 4
Fixed-Temp(Other Than Fusible Metal Alloy Type)& 7 3 5
3.9 M Heat Detectors Maintained or Replaced
3.10 M Auxiliary Equipment Such as Water valves 7 3.3 1(2) *ily. 0 1
Functioned Correctly .
3.11 M Internal Maintenance as Required by Manufacturer Title 19 l904 7 9
D=Deficiency C=Comment (Indicate type) _
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/tern -, D .mwsert Vaii =Y1 ?)r . •c- , if �td4-Athkekr �rr=!Hra3y
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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. j
Print Name O (A. ` L?
Signature —
I Date - Zj - Zp
�� 4�
Form AES 20 Sept.3.2013