HomeMy WebLinkAboutFAI21-0016 078-110-036 CF Hood 7-2022 `. a nar ;;t ,.,u ., r1 m i 4A i '''' 1: , 'irt i' - u d ndl I 1 u Id, ail al -
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Fire Extin.uishuig System„ ... :~inspection,Testing,and Maintenance Report __;
Property Information ��� �p� Contractor or Licensed Owner Information
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'Building Name \ e�1 Sbyt_ S c Tom, 4 - n 'Name Wilgus Fire Control Inc.
'Address ZZ c (v�it 9 . 4Q 'Address 4544 Mountain Lakes Blvd.
J ,P7R MPS 'City Redding St. CA Zip 96003
ICity —17/\1.12-- 't I ;-h-1 (License# 462979 (Phone 530-241-2465
'Contact Person .Pteuip_e 1 ❑ SFM 'Job# 3 (a(Q 2
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'Phone ---1 (. z_,. n tz)�, I ® CSLB 'Misc.
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System infornlatiorl �'` r ' '•- ,�
(Cylinder Size cia,1 1 Art Last Hydrostatic Test Date 20 Z n Flow Points Capacity Used G2
ISystem Location ' 1,,,�ex..1 t System Mfr. itl-r,c,,,_j,_ Model# 12_, t n•7.. --
IFuel/Heat Shut Off: - - -
/IGas# '1 1/4 / Electrical.# /Integral Make Up Air Shut Down
1. Items '' #of Items Dimensions ) I Points Nozzle Nozzle INozzle I Total
Model# FlowQty Flow Points
'Hoods I I I-1, 'X y ' : - -1 - -- — II I -
'Plenums I / -1 ..) - ------ I-1(,) - I - I I ( I 1_
'Ducts I .I I i e-I 'r k (. ---I l-J__; 1 t ---- I 1 I c
Cooking Appliances
Left to Riaht with Sizes and Coverage Nozzles
• __
Nozzle Nozzle Total Nozzle Nozzle Total
Appliance Name (Flow
Appliance NameFlow Points Points Model , Flow Points I Flow Points
Rc.fl ;3'4 k/ 121 4 — 1 .Z 1--4----. 1-1 _ I II
111
I- I I I I I I
I I
I I II I I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links) _
Quantity Temp
Mfr I Install Mfr — Install
i T Quantty emp
Date . Date Date Date
2— I `-f gb I "Zr,7_fl I-1 — 7/,, - 7,7 I 1 1 1 1
I — I - - - —'11 1 I I .1
nspection, •
Testing, and M; n e nce ri T
I =Inspection T =Test M= Maintenance P=Pass F=Fail N/A =Not Applicable• �—
Item Description NFPA 17A CA Date Comments Only P,F,N/A
I ed.Reference ( I. __
I Manual Actuators are Unobstructed
1.1 7 2 2(2)
(i.e. Remote Pull Station) I I� -
1.2 I Tamper Indicators&Seals Intact I 7.2.2(3) I / I P
1.3 I !Maintenance Tag in Place I Title 19$906 I I P
1.4 I (No Obvious Physical Damage I 7.2.2(5) I I I i---"
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1.5 I (Gauge Readings within Proper Limits I 7.2.2(6) I I I tlA
(Stored Pressure)
1.6 I (Blow-Off Caps in Place&Undamaged I 7.2.2(7) I 1 I
1.7 I (Hoods, Ducts, Filters in Place and Clean I CFC 904.11.6.3 I I Iie
1 8 I Hood, Ducts& Protected Cooking Appliances Have 7 2 2(8)
Not Been Replaced.Modified or Reate locd \ I /
! 2.1 T 'Automatic Detection/Manual Actuation Functioned 7.3.3.4 \ f)
! 'Correctly I I !
.I.
I=nrm Ad:: _)n - -c'--
et y t I " t -'' i I .' 'III f , C ; - =1 II'I!I ; ■III 1 ,i II i ," „'i•1 IAI
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Property Information -9f AL pi, Contractor or Licensed Owner Information
kV'Building Name 1v e C A n J(` >A na i f‘c4( \4 �)5) 'Name Wilgus Fire Control Inc.
Address `Z? ± h q`�`��y'°V Q, Job#
Vs Icitr--r iin.P Dmr i `-i- ql.E M2 I
—
I `rx* _ inspection,Testing,and Maintenance := t'°.;.-;. .-
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
iNFPA'17A CA
Item Description I ed.Reference I Date I Comments Only P,F,N/A
2.2 T Fuel Shut-Off Operated Correctly I 7.3.3.4 I-1_26 P
2.3 I T Regulator Tested&is within Acceptable Limits I 7.3.3.4 I I I P
2.4 I T Manual Reset Relay Functioned Correctly I 7.3.3.4 I I
(If Applicable)
3.1 M All Agent Containers within Acceptable Hydrostatic 75.1(1)
I Test Dates II I F
3.2 ( M All Auxiliary Pressure Containers and/or Hose
I 7.5.1(2)(3) r(I I /I A I Assemblies within Acceptable Hydrostatic Test Dates
3.3 I M Cartridge Weights within Acceptable Limits I 7.3.3.1(2) I I I 14D
3.4 I M Liquid Level within Acceptable Limits I 7.3.3 1(2) I \ I P
(Non-pressurized)
3.5 I M No Signs of Corrosion in Agent Cylinder I 7.3.3.1(2) I I
(Non-pressurized)
3.6 M Distribution Piping Unobstructed and Contiguous I 7.3.3.1(3) I
3.7 M Nozzles are Correct,Clean& Properly Aimed I 7.3.3.1(2)
g g I M Fixed Temp Fusible Metal Alloy Type Detectors Replaced! 7.3.4 I I I •P
Fixed-Temp(Other Than Fusible Metal Alloy Type)& I I I
3.9 M Heat Detectors Maintained or Replaced /
7.3.5
3.10 M Auxiliary Equipment Such as Water valves I 7.3.3.1(2) I . \ ilf Its'
Functioned Correctly
3.11 M Internal Maintenance as Required by Manufacturer I Title 19 004 7 I r/ I
0=Deficiency C =Comment (Indicate type)
Deficiencies and
Item . Date Riser D , C Indicate all equipment.devices andparts that am rppp red or •.la •:d
II
I-... ... .. .
I I
II
.1 Check here if additional Deficiencies and Comments are listed on Form AES a Number attached:
i..I 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 PI Lt. j( t r
Signature 41,—Mu - w/u Date 7.. 7 .0 _ Z-2_---