HomeMy WebLinkAboutFAI15-0060 031-260-016 CF Hood 7-2022 tCfiemical-Pr .i.': : i ''' '' ' ur'J 1 i . '! W q • 1 i 4' ''
Fire E .i uishin "S em t s ec estin and Maintenance Report of
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Property Information •4,4�"-`�4*oi Contractor or Licensed Owner Information
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'Building Name 5 , 1_94.0 Cj G�.Da I i n (Name Wilgus Fire Control Inc.
'Address I i) 2 3 5; 4.4-9...0. A .L.- I •9‘, .•,tr 'Address 4544 Mountain Lakes Blvd.
I _ I SfiP'S (City Redding St. CA- Zip 96003 y�
!City 'VIA,,Zq k 1‘.3r� — (License# 462979 (Phone 530-241-2465
�IZC�I,J - ----I O SFM 'Job# •3G� 6
Contact Person 2 ji
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(Phone "j t -- D l bD 12.1 CSLB 'Mist. I
System Information ,+ ,
!Cylinder Size 3 q a I t n✓L Last Hydrostatic Test Date 'at,Z.b Flow Points Capacity Used Li
'System Location illln 11
System Mfr.q f 15 LA 1 Mnriel# (Z - ay,
(Fuel/Heat Shut Oft
'Gas# ( t/2 II Electrical# 0"- Integral Make Up Air Shut Down /-
Items a '-- #of Items Dimensions Nozzle I • Nozzle Nozzle Total
Model# Flow Points I Qty I Flow Points
(Hoods I I I If ' x N ' I I I I
(Plenums I / I �S — I i I).) I I. I t I \ -
IDucts I i I ktt x Ist i I. ( l3 - I -k I I I 1
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name Nozzle Nozzle Total Nozzle Nozzle Total
( Model Flow Points)Flow Points Appliance Name Model Flow Points Flow Points
6,z- d•;cc1� Zx t I i N .. ....._I i_ ..I- k. -I
Pant,0_ -Z.-1 x z-7 i z -R II t I 1 II I I I I
-- I I I f I I _1
I I II I I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links) _
Quantity I Temp I Daft InatPll Quantity I Temp I Date I Install
Mfr
Date
—
. I Li SD I 2 z c -.Z I -.u-- zz1- I I I I
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I 1 - II 1 I I
Inspection,Testing, ant!Maintenance
I =Inspection T =Test M= Maintenance P=Pass F=Fail N/A =Not Applicabl. _
Item
N Reference A CA Date
ed. Reference Comments Only P,F,N/A
r Description r,
1.1 l (Manual Actuators are Unobstructed 1 7 2 2 2 /'�
` (i.e. Remote Pull Station) O -Z � T'
1.2 ( I (Tamper Indicators&Seals Intact I 7.2.2(3) , I P
1.3 I 'Maintenance Tag in Place I 7.2.2(4} I I
Title 19$906
1.4 I INo Obvious Physical Damage I 7.2.2(5) I I I P
1.5 I Gauge Readings within Proper Limits f 7 2 2(6) pr
I(Stored Pressure) I I
1.6 I IBlow•Off Caps in Place&Undamaged I 7.2.2(7) 1
1.7 I (Hoods, Ducts, Filters in Place and Clean I CFC 904.11.6.3 I I I
1.8 I l !Hood, Ducts& Protected Cooking Appliances Have I (
7.2.2 8
Not Been Replaced,Modified or Relocated ) I
! 2 1 T [Automatic Detection/Manual Actuation Functioned 7.3.3.4 •Ny
I 'Correctly I
Fnrm GGc ')n _.... .
Fire E xtin g uOhin 'S stem Inspection;Testing,and Maintenance Report
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of ca�i it
Property Information c�. ,°pt� Contractor or Licensed Owner Information
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(Building Name S. S C.kna 1 ) ( C. }i.›i 'Name Wilgus Fire Control Inc
(Address t823 `�c .f�� -(1A AO I-- t1 > . U°,_ . ,Li !Job# 'j Q(0 Zco
'City '� A.Q.pJAt l Z-� ZLl E MP�
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Inspection,Testing,and Maintenance
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1 = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =No!Applicable
NFPA'1*CA
Item 1 Descnptioh Date Comments Only P,F,NIA
ed:Reference.
2.2 T 'Fuel Shut-Off Operated Correctly I 7.3.3.4 17 - zz) P
2.3 T 'Regulator Tested&is within Acceptable Limits I 7.3.3.4 I 1 I I t-
2.4 ( T 'Manual Reset Relay Functioned Correctly I 7.3.3.4 I '
(If Applicable)
All Agent Containers within Acceptable Hydrostatic I 7.5.1 1
3.1 M (Test Dates ( ) _—
IAII Auxiliary Pressure Containers and/or Hose 3.2 M I 7 5 1 2 I I I I A-
ssemblies within Acceptable Hydrostatic Test Dates ( )(3j
3.3 I M 'Cartridge Weights within Acceptable Limits I 7.3.3.1(2) I I I
3.4 ( M (Liquid Level within Acceptable Limits ' 7.3.3 1(2) I I I I P
(Non-pressurized)
3.5 I M 'No Signs of Corrosion in Agent Cylinder I 7.3.3.1(2) I I I P
(Non-pressurized)3.6 M 'Distribution Piping Unobstructed and Contiguous I 7.3.3.1(3) I ` I p
i-
3.7 M 'Nozzles are Correct, Clean& Properly Aimed I 7.3.3.1(2) I I P
3.8 M 'Fixed Temp Fusible Metal Alloy Type Detectors Replaced' 7.3.4 I
3.9 I M 'FHeatixed-TempDetectors(OtherM Thanaintained FusibleorReplaced I l Metal Alloy Type)& I 7.3.5 I ` I ti P
3.10 ( M 'Auxiliary Equipment Such as Water valves I 7.3.3.1(2) I \ \ I I0lf
Functioned Correctly
' 3.11 M 'Internal Maintenance as Required by Manufacturer I Title 19§904 7 I Nr I I P
D= Deficiency C =Comment (indicate type)
- . _ Deficiencies and Comments
4tert3 a F. - f'• `. Riserdicate all egwpmenl,devrces,and p, sjhat iver..•• ,._.:k,, .,_�_,.._q
w s ,,-•. D- 'kC (red orreplaFed
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-]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 -.1-1) t,,,‘• M.tive11 Z2---
ISignature I .*M 7)-1/41,k,wk Date -7 — ZS - 22___ 1