HomeMy WebLinkAboutFAI18-0012 CF SHI 2022 f Wreeti initial Pre-Engineered California Code of Regulations-Title 19 Semi-Annual`: - :: . .T.-,.
Fire 4 uiehm S stem Inspection,Testing,and Maintenance Report —
Property Information 4.-'- -A{\pp) Contractor or Licensed Owner Infer ii,ali,-)
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Building NamE ju L rcc c;e_Z C,�,{cL� 5.k(�� i 1 di)11,
Name Wilgus Fire Controlln .
Address to.4 ' -c -t '. °vr .•, Address 4544 Mountain Lakes Blvd
1,1st,� City Redding SI. CA ?ip 96003
City fitcvel a(�ct 'License# 462979 Phone 530-241-2465
iContact Person L.5 p-/..- I ❑ SFM Job# sip& 3i
Phone - -- 4141- -,3 c 4 -- 1 ® C S LB Misc.
. Sy44m lnfor ri firm
Cylinder Size G, l i t.,., k _ Last Hydrostatic Test Date Zp I-2, Flow Points Capacity Used 't C
System Location ' LOc., 14 System Mfr. -A n 5 irk L Model# v_-- 1 f) L-Euel/Heal Shut Off. _
Gas# / Electrical# ,- Integral Make Up Air Shut DownR� —
Items I #of Items I Dimensions Nozzle Model# I 1 FlNozzle
aw Points I Nozzle
Oly I Total
Flow Points
Hoods I ,'fi 'r I ' et I I __. .ItT I L I 2 I 2-
2 _ It'1/Iz X t2- I4 ta) I
Ducts I Z I -- —
Cooking Appliances ,
Left to Riaht with Sizes and Coverage Nozzles
Appliance Name •I Nozzle Nozzle I Total Appliance Name
Model Flow Points Flow Points Model Flow Points Flow Fonts
l e-cddi L, 3c.x z'i I j9 n ._ '2.__- . . 1 Z'. . I I I I -__- ____
v_titin- 2lk2.5 _I ‘ rr:1 I i _ t _1 _..
I(Iu,eR 14 x -2-i Izq�, '2.--1P_-a.�ia 3laX Zto Izx -zqv I 7.. (-1Ti -1 '
- _ 1
uanLR_ L X + '... I t cf I C I 2 I I I I E
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity I Temp I Mfr I Install - Quantity I Temp I Mfr f
tns;au
Date Date Dale Date
1-3 I �-tSC�
1 1 2wzb Iti - Li- 7-`2.-7-`2.- I I I
I # —_____-_.
I
-- II I I 1
itt�{[TeGtion,Testing, and rillainiouaoco..
1 = Inspection T =Test M= Maintenance P=Pass i= =Fair N/A =Nor Apphca%z!e
i
Item IVFPA 17A CA
1 Description - 'ed.Reference Date I Comments OnlyI P,F,N1A
1 1 i Manual Actuators are Unobstructed ' 4 1
lie. Remote Pull Station) - 7.2.2{2) I I ?if- I I P l
1.2 I ITamper Indicators&Seals Intact 7.2.2(3) I 1 P l
1
1.3 I I 'Maintenance Tag in Place 7.2.2(4) I
-- I Title 19�906 I I ! P i•
1.4 I INo Obvious Physical Damage I 7 2 2(5f p
1.5 1 Gauge Readings within Proper Limits - 7.2.2(6) ``'I A-
•
Il-- _.__
'(Stored Pressure)
1 6 1 +Blow-Off Caps in Place&Undamaged _ I 7.2.2(7) I P
1.7 I (Hoods,Ducts,Filters in Place and Clean I CFC 904.11 6.3 I I I t P
1.f3 I 'Hood,Ducts& Protected Cooking Appliances Have I 4ed 7.2.2(BI
Not Been Replaced,Modified -- �� P
or Relocated A �_.
I
2 1 T utomalic DelectionlManual Actuation Functioned 7 3 3 4 I P •
,ICarrecity
Wiarefiemtb rPre-Engineered California Code of Regulations-Title 19 Semi•Annual 2 of 2
. Fire,Iwxtinguishing System Inspection,Testing,and Maintenance Report ._
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Property Information ,s4-. ----of Contractor or Licensed Owner Information
Building Namie„AA e..._ y. (ig_� ' ,�-im r�r,( ( #)n i Name Wilgus Fire Control Inc.
/�r ill #.
!Address `t.ro Sfi21 ge..p.- 0� /t9'4,` } � Job It -36
F
Icily a q�1 ; `''1 Mom,.
-3 a- _. i. Inspection,Testing,and Maintenance ,- '
I - Inspection T =Test M=Maintenance P=Pass F=Fail N/A-Nol Appfrcabte
--
NFPA-17A CA
Item Description d Ft (pr I uafe ,.I Comments Only P,F,N1A
es: eiee
2 2 T Fuel Shut-Off Operated Correctly 7 3 3 " Itt- '-zL1 e_____..._
. .2.3 T IRegulator Tested&is within Acceptable Limits 7.3 34 ! 4 I T
Manual Reset Relay Functioned Correctly .
z-4 TI
Of Applicable) 7.3.3.4 e
3.1 � All Agent Containers within Acceptable Hydrostatic 7.5.1f 1) -
Test Dates
"All Auxiliary Pressure Containers and/or Hose
3.2 M 7.5.1(2)(3) I
I Assemblies within Acceptable Hydrostatic Test Dales
3.3 I M 'Cartridge Weights within Acceptable Limits 7.3.3.1(2) I I I P
Liq.nd Level within Acceptable Limits I
34 M 7.3.31(2)
(Non-pressurized)
3.5 1:r1 No Signs of Corrosion in Agent Cylinder 7.3 3.1(2) I I e
_ (Non-pressurized)
3 6 R1 Distribution Piping Unobstructed and Contiguous 7.3 3.1(3) e
3.7 M Nuzzles are Correct.Clean 8 Properly Rimed 7.3.3.1(2)
3 8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3 4 I P
I - 'Fixed-Temp(Other Than Fusible Metal Alloy Type)8 7 3 5 �
3.9 M Heat Detectors Maintained or Replaced
3 1D_ MAuxiliary Equipment Such as Water valves 7 3 3 1(2) 1 1 0‘pt
!
Functioned Correctly . ._..-
i 3 11 M Internal Maintenance as Required by Manufacturer Title 19 t;904 7 I
} D= Deficiency C=Comment (indicate type)
. , ' t�, .•i- g'j Riser D C Deficiencies an. omments
" a ?i , °'-t,.. .2 ,,_.. _ . .. . .. . h)d;c::te$letglur R19ft.dev;ca5e3udpwts_ltet Y.t?1a ra:),-_ , . - - '- __.
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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:
t hereby certify that the fire protect/on 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 907 to 906 and that the equipment is fully operable
! except as noted in the "Deficiencies and Comments"section of this form.
Print Name D t p kv-E-( `t- - / SY —
Signature - -- M 714itt,ti..t d,r-- Date t t_11- Z 2-,.—