HomeMy WebLinkAboutFAI18-0002 031-172-082 CF Hood 7-2022 r1' Alit- - .t : .11 . t. . 1 • ,i ; li _ .1 l al_ 1 of2
Fire'Estlpguishing System Ittsppation,Testing,anttgllntenance Repprt -
Property Information .st, ptl Contractor or Licensed Owner Information
A4 -Pz
'Building Name 47tLLIAaS 5 Gti.aa I /�� v 'Name Wilgus Fire Control Inc.
tIA'Address Lk P Wass pro ' q``. �Q7 !Address 4544 Mountain Lakes Blvd.
I 1,4.7RE Mp4 !City Redding St. CA Zip 96003
(City` 1' vQ_tuvC; Is,*a (License# _ 462979 (Phone 530-241-2465
'Contact Person Pk p d g e_w I ❑ SFM IJob# .3 &62 IC? _
'Phone 53 1 lZ 0 k.aa I ® CSLB 'Misc. __.
Size Last Hydrostatic Test Date
ys�em,. !i ° _:.
'Cylinder °3 ga�llnv� y L-At.‘,..) 2a22— Flow Points Capacity Used _S---
'System Location (o (( Sys.tem Mfr:-H n.„_,1 Model# g ►fl 7— --
IFuel/Heat Shut Off: _ r
'Gas# 1 i f N./ Electrical# ✓ Integral Make Up Air Shut Down ✓
Items I #of Items I Dimensions I Nozzle Nozzle Nozzle Total
Model# I Flow Points I Qty I Flow Points
'Hoods I 1 14 O X H ' I _ I I I _-- -_--..
'Plenums I j I c /` I I t,,1 I 1 I l I 1
'Ducts I ! I .2— " x " ( 1 taJ I t I 1. I k,_,.y
Cooking Appliances
Left to Richt with Sizes and Coverage Nozzles
Nozzle Nozzle Total Nozzle Nozzle Total
Appliance Name Model I
Flow Points Flow Points Appliance Name Model Flow Points I Flow Points
IK0-r\L1�'3t�x 21 I t ' I ) -I --_ I-I I
I I 1 4 I I I I __ - 1
I I II I I
III I II
Fixed Temperature Sensing Elements
(Such as Fusible Links) _
Quantity I Temp I Mfr I Install Quantity I Temp I Mfr I Install
Date Date' Date Date
'7. I l't 57) I •2z5 z r) I'].- ?A'- 2 7-1 I I I I
Inspection,TestinC4l ', rn►ltenance y 4, -,
1 =Inspection T =Test M= Maintenance P=Pass F=Fail N/A =Not Applicable _
Item I I Description ( NFPA17A CA I ed.Reference Date Comments Only , P,F,N/A
1 1 l 'Manual Actuators are Unobstructed ' 7 2 2(2) I�
fi.e. Remote Pull Station)
1.2 I 'Tamper Indicators&Seals Intact I 72.2(3) i I P
1.3 I 'Maintenance Tag in Place I 7.2.2(4) I I T.
Title 19 4906 _____
1.4 I INo Obvious Physical Damage I 7.2.2(5) e
1.5 I 'Gauge Readings within Proper Limits I 72.2(6) I ' �
_ ( r
(Stored Pressure) _ t
1.6 I IBlow-Off Caps in Place&Undamaged I 7.2.2(7) I \ I
1.7 I i 'Hoods,Ducts,Filters in Place and Clean I CFC 904.11.6.3 I I Q
Hood, Ducts& Protected Cooking Appliances Have
1.8 I I 'Not Been Replaced,Modified or Relocated I 7.2.2(8) \t)
/ I
P
2 1 T 'Automatic Detection/Manual Actution Functioned 7.3.3.4
Nr
'Correctly I P
Fnn„ G�c •)n ^r,, ,,
..✓� - •1i i, 1w Yi; I. ,41.1�,
etti ( 1I n I ,� r : li - �Ili'u�i1ndl� ,.''t+ r�� i 114.1� 411
Fire
Engu)shing System_ .. Ins{pction,Testing,and Maintenance. . :Report
2 of 2
Property Information <<c�F CQ�i°pt� Contractor or Licensed Owner Information
(' a
'Building Name (A i Im a s s r`.k.,T ( i(( \. � ji 'Name Wilgus Fire Control Inc.
'Address �4 t7 P(t u► &s 1 v l9rF`�i / 'Job# '36262 l9
ICitya-c'kn iZM i (;--1--r. 1�-E M
x, Inspection,Testing, and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Item ( Description ( edPFA'17A CA Refe ante ( Date I Comments Only I P,F,N/A
2.2 T 'Fuel Shut-Off Operated Correctly I 7 3.3.4 I-7_7C•771 ,P
2.3 T 'Regulator Tested &is within Acceptable Limits I 7.3.3.4 I ( P
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4 1 P
(If Applicable) I I
3.1 M I (AllTest AgDates I I ent Containers within Acceptable Hydrostatic 7.5.1(1) 1 I n 11`�
3 2 MAll Auxiliary Pressure Containers and/or Hose ' 7.5.1(2)(3) I I ( �cA
Assemblies within Acceptable Hydrostatic Test Dates
3.3 M 'Cartridge Weights within Acceptable Limits I 7.3.3.1(2) I I I I Q
3.4 M 'Liquid Level within Acceptable Limits I 7.3.3.1(2) I I I I P
(Non-pressurized)
3.5 M INo Signs of Corrosion in Agent Cylinder I 7.3.3.1(2) I P
(Non-pressurized) _
3.6 M 'Distribution Piping Unobstructed and Contiguous I 7.3.3.1(3) I P
3.7 M 'Nozzles are Correct, Clean & Properly Aimed I 7.3.3.1(2) I ' P
3.8 I M 'Fixed Temp Fusible Metal Alloy Type Detectors Replaced' 7.3.4 I
3.9 M 'HeatFixed-Temp(Other Than FusibleorReplaced 7.3.5 Pt
Metal Alloy Type)& I ' I 1
Detectors Maintained
3.10 M 'Auxiliary Equipment Such as Water valves I 7.3.3.1(2) I I kV(]r
Functioned Correctly
3.11 M Ilnternal Maintenance as Required by Manufacturer I Title 19§904 7 I y I I P
D= Deficiency C=Comment (Indicate type)
Item Date Riser D C
Deficiencies and Comments. :
•__ -... 1000.0 equipment,_devices and arts t at :erq re•aired orre•la,, ,. _: 'r,
I I 11Z ►ante >2— CzQ-ola.c-IivIE + CS A10:-+La.
II ric Ld. - - - c k-- G.,(.?_ I - Cae-+mirk e_ (-1 c_
_ L r..�� �DS —t" �ri in i rm�
1.- I -..-1 • ,
11 I I
i I I I .I
I__ I I
_I Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
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 le)tM et U-1✓1 (- - —
Signature Date 1 zT— 22