HomeMy WebLinkAboutFAI16-0002 042-070-197 CF Hood 2.2022 F1 t(0--aci° z- c)(-f 2.--4 70—i
w firtiTo-- dti '' 'e-Engineered California Code of Regulations-Title 19 - -i . =
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=;-'":iireeXtingttistiing System Inspection,Testing,and Maintenance Report
,1 -0, , ---114/;111 Property Information - ',41,61 ,0.4,jh
,4\Sy) Contractor or Licensed Owner Information
,-, ; • 11)( f7- ).-1;) Name
14/ 6' I.'Building Nanie. cil,*(ti 4,,,6e il.i c 4.-"1. .4.'1,'" ‘, Wilgus Fire Control Inc.
Address --'
LO le .1-/Arl/a* tiv.) -.:4(.-..5", zfl,r Job#
Alct PiejejAiSI''°'../
City
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'1' V"Wft4-447 ItiSr.RICtioti, Teeting, and Maintenance
I =Inspection T =Test M=Maintenance . _ ..,„.. . P=Pass F=Fail N/A=Not Applicable
r.j.,, es ,44.0„ „,„. , 1 , , I , ',- • , ottiments,001 , ,,, I p
,e, t ,fpritr 74., Agit/- -4, -„,,,,„ , , ,. ,
Item .. ,y-- .. ., ' -Q-C,,'',7*,.:1-V, , , „,.. ;,,,,, .,, , .,„ ,,,, , ,.4.0p,,, elv..4.r. ' , ,--:- -
2.2 1 Fuel Shut-Off Operated Correctly I 7.114 I I 1 da
F1+1/A
2 3 1 Regulator Tested&is within Acceptable Limits I 7.3.3.4 I
I I i 4/14
,.. ----- Manual Reset Relay Functioned Correctly 7.3.3.4 )191'4 1 (If Applicable)
-1
4 All Agent Containers within Acceptable Hydrostatic I 7.5.1(1) I e
All Auxiliary Pressure Containers and/or Hose
3 2 M 7.5. P1(2)(3)
,
Assemblies within Acceptable Hydrostatic Test Dates
., ,...._....
3 3 fv1 Cartridge Weights within Acceptable Limits I 7.3.3.1(2) I
3 4 I m . Liquid Level within Acceptable Limits
(Non-pressurized) 7.3.3.1(2) I I I
11'
No Signs of Corrosion in Agent Cylinder
3,5 M 7.3.3.1(2) I
I I f
(Non-pressurized)
..... .__ . ___
•
3.6 M Distribution Piping Unobstructed and Contiguous I 73.3,1(3)
I I li
3 7 Iii4 Nozzles are Correct,Clean& Properly Aimed I 7.3.3.1(2) I I ..."tl
3,8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced' 7.3.4 I ,
FixedTemp(Other Than Fusible Metal Alloy Type)&
3,9 fvl 735 I kiliil
Heat Detectors Maintained or Replaced . .
Auxiliary Equipment Such as Water valves
3 10 MI 7.3.3.1(2) I)V14
Functioned Correctly
3.11 fv1 Internal Maintenance as Required by Manufacturer I Title 19*904.7 I IV/A'
___...... __
[ D=Deficiency C=Comment ,, Indicate type) ,..„,...,
-eficiefIcir s and COrturrnts"
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911111111111M1 1011111111!
inatme frame
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,Check.lime 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 16-41 it/afre,ce ri-i
Signature q--)1------ Date ,;?--•2 '-„2:2_
• .
',,. 16 ,--' B k al l w-19� N 1 1{il, it IYi '1 II 14 116 1 �I I ii a VII 14 i nl 1 1 1 'YI II ;1 t, 119 .. i J 1 • —p b ,a
�r ? ? tt$S ..; ...._ fttsp ctiQtl,Testing,and Maintenatlae Report,
,
'4'OF CA</�t
Property Information ',�ti�• w ‘�oi Contractor or Licensed Owner Information
ti4 Kx
Building Name ej ,•4,0, go4,7,�!'e ()s.,, .,^..r " �' Name Wilgus Fire Control Inc. _.ti .
Address ill 0 CV Eli.y-7 ,4...Ve -9,,,fi`�� .--,;,Z� Address 4544 Mountain Lakes Blvd.
I1if tytPQ` ICity Redding St. CA Zip 96003
City ('C) U y ILicense# 462979 !Phone 530-241-2465
Contact Person I ❑ SFM !Job#
Phone 3%2„ 71Iv-3 0 CSLB IMisc.
F . . , ate '°ys ein. a ora p 4 on -,. .,i....
... _. _. ..__
Cylinder Size "'j ,, Last Hydrostatic Test Date f e, Flow Points Capacity Used ,,,
System Location j(,'re.I System Mfr. �-it A5 l_ Model# (j( /0 2
Fuel/Heat Shut Off: _ ..._—
Gas# w-� ` Electrical# Integral Make Up Air Shut Down
;... 4 4, � 0, l '� 7" A lozzie Total
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n?
Items: ,i+#ofltems ,P rr t�i nsi � `" �'4 � � Flow Points s.,
Hoods
I X
Plenums I t I I 1 IV I ) I 2-- I
Ducts I / 11 1 X z.3 1 .?,, I I ( I 2_.
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
�,� Nozxle"�{ " illA,Pu,le 44? 'ota,I:. �s Nozzle I Nozzle Total
met
.51 q� $ , '*$ 1� Model FIow;Foints -,,F10'PointsV E E N a F-4¢ppllence dame , z , 9l a�_ N,,R4 :.Flow points Flow Points
I 6 liccr. '-.c v I 11: r . _ I I I 1 __ _
.
�� �ti f II
1 _ ....
I I I I II 1 I.
I I I I I I I I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
r ; ;8€s x r Mfr 3 � a i ii I 7 .3 ra .i Mfr Install
Quaht4ty r Tamps I � �§ 4uantlty � emP Date
�. ' i , .Dati`
s� Dad ...' ,� � T . .
I '3 G<,o 1 ?, z. I �-
I I I I 1 . ._...v__... ._
, inspection,Testing, and Maintenance 44
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
's m a -, , E yes ,,,, -4,7,z,.tom, r.t z z _ ,,
,s 1 I i_ . � i ktiktf � ,A, . .•..1,. I lap
erenc RN r, ' xf, ;, Only P,F,NiAis
1.1 I ( 'Manual Actuators are Unobstructed 7 2 2(2)
(i.e. Remote Pull Station) I.
1.2 I I !Tamper Indicators&Seals Intact I 7 2 2(3) I I _ _ t
I 1.3 I !Maintenance Tag in Place Title 722(1 $406 I I
) a
I1.4 I I INa Obvious Physical Damage I 7.22 5 I
Gauge Readings within Proper Limits I 7.2.2{6) Ail/?
1.5 I I I(Stored Pressure)
1.6 I I IBiow Off Caps in Place&UndamagedI 7.2.2(7) I
�_.
41/
I1.7 I I (Hoods,Ducts,Filters in Place and Clean I CFC 904.11.6.3 I I d
1 8 I I Mood,Ducts&Protected Cooking Appliances Have 7 2.2(t3) I ._.
Not Been Replaced„Modified or Relocated
I (2.1 T utomatic Detection/Manual Actuation Functioned 7.3.3.4 I I I�
!Correctly