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HomeMy WebLinkAboutFAI17-0001 Mid Valley Baptist Church 6-27-23 • r r: v.or♦ -fa:: I.. III ' Ii a: : Yd -. yklk: �' 3• ld,�.. ' • •. ' California'?l:`t y' , r� ' ` Y. . j • 'vj` - . ' c . Title Wet mica Pre; ' � peered w • i :c i;i. • ` t t: qw;: t and Malnte eaaS\ >`E� , _ ,!�6'Y . : :ice . -.:..; .�C,' ,..,. . /.t:� . :.r . . . f�dai,,,, . . . 3. � .oi . . . . . _ .:.�.•„P,.dnbab . . . . . . . . . . -. . - .. , • �� :EC4� � ' . tPro e Information Contractor or Licensed Owner Information .'f;e4I/ F7' •-cc N\ra: )yi\ 1 \I 't f " na*'. . _ ^ \i 5ir v :.4..� ...w/ 4, ' 015 14 • ali . Building Name s 6 pt Name Wilgus Fire Control Inc . Address t" apfri44 ' Address 4544 Mountain Lakes Blvd . • kEP- � City Redding St . CA Zip 96003 City et tt i.A - License # 462979 Phone 530 - 241 - 2465 Contact Person I El SFM Job # Phone ft .44 f 7L� , 1 2_ CSLB Misc . • _ . . . .,. . .. ..:.:.. 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Plenums II(/ I It / Ducts I l 1 ) `l 1 I 26 } I 1 I 1 Cooking Appliances Left to Right with Sizes and Coverage Nozzles Nozzle Nozzle Total Nozzle Nozzle Total Appliance Name Appliance Name Model Flow Points Flaw . Points . P . . . . _ del F w♦ „ v M Flow Points Flow Points ‘ie busivAl44-• I le I -2- l'/6/ 2".- _ . . . . . . . i 1 II i I 1 1 i . . . . . . . . . . ..r, ,..__ . . . . . . , . . _ _..._ - . . , . - . . . . . . . . . . . . . . . . . . . . . . . - kill . ...•,.'••---.• ..]tom.. s ii . . . . . III . Fixed Temperature Sensing Elements ( Such as Fusible Links ) . .. H, . . . Mfr Instal ! d Mfr Install Quantity Temp Quantity Temp Date pate q . . . . H.hv.., Date Date A -r� . . ,. . .r,.. N . . M L.r . - .� . . . . , . . . . . j . Y .. .. . . .. . , , 7MMt MhNNMMM tt A1Nh. . 414114.404WoWil4WMINAWIAWAYS MWAION MMINIM<. . . . . . , : , : : • . . . . , . • ... :: V . . . :.. . ( k:A ,,r:%:<qW JM+,t< `CC',K ^7 :;�a. . 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Maintenance Tag in Place 7 . 2 . 2 ( 4 ) Title 19 '.. 906 n _ ww .rww • 1 . 4 1 INO Obvious Physical Damage 7 . 2 . 2 ( 5 ) 1 . 5 I Gauge Readings within Proper Limits 7 2 2 ( 6 ) ( Stored Pressure ) �, .I 1 . 6 I Blow- Off Caps in Place & Undamaged 7 . 2 . 2 ( 7 ) / , . . . , . . . _ . , , , , . , . w. �. • 1 . 7 I Hoods , Ducts , Filters in Place and Clean CFC 904 . 11 . 6 . 3 O • � , . 1 8 I Hood , Ducts & Protected Cooking Appliances Have 7 . 2 . 2 ( 8 ) Not Been Replaced ., Modified or Relocated ,,,,� _ w.:..:. .:.:..,:, ::. . . : . 2 . 1 T 'Automatic Detection / Manual Actuation Functioned 7 . 3 . 3 . 4 • Correctly „....c c.t ♦.., � . Form AES 20 Sept . 3 . 2013 i%n.<di?T.�:t::``tC,{.`ryY'}l. . 4,..0. xr>i4:i:S.' J < h v�:<••.. ' ��:':: .k>l . ., .._. .. . . . ����� .. .. . .. . ..., . ... . .. - - . . . L 3 2 yrs . ,: . _ . owl IN JJ lU Y ,I 14 Ia 111 NI.... I .JI ., Y> \ � 3 i ,I . . . _ . 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'>%:,a:i'S"�; `. .2 ' >.tar ..,,; '�i'.. .t . y. •.J). �.},r.J;4'$%F�} � �'; :.,,'X'. )� :� y: , • Iw Inspection . . . . :. . . y: { .a't {.,>w.w. K .4 � r��£� <vs.ra` J.�k,...l� . , . . . . r. .. ^ . . � � . . - '� rye, . •' . � , +� . d:£' �aY:.3 ia .''S,' .•. . . . T - Test M Maintenance P = Pass F - Fall N/A - , , , Not Applicable • • . . . . . , to P. . . v rid . . ^, , C . . , v , . , f . . ::: .::. . . . . . . . :. . . .• . . . . . . . . . . . . . . . . . . . . . . .• 2 . 2 T Fuel Shut-- Off Operated Correctly 7 . 3 . 3 . 4 ir . . . • 2 . 3 Mµx• T Regulator Tested & is within Acceptable Limits 7 . 3 . 3 , 4 /.� Manual Reset Relay Functioned Correctly 2 . 4 T 7 . 3 . 3A ( If Applicable ) l f' �) 3 . 1 NI All Agent Containers within Acceptable Hydrostatic 7 . 5 . 1 Test Dates 1 , „ , 3 . 2 All Auxiliary Pressure Containers and/or Hose 7 . 5 . (2 ) ( 3 ) Assemblies within Acceptable Htdrostatic Test Dates //...; /(..-, 3 , 3 M Cartridge Weights within Acceptable Limits 743 . 3 . 1 ( 2 ) Liquid Level within Acceptable Limits /<_,/ 3 . 4 M 33 7 , . . 1 (2 ) • Non -pressurized ) - I j 3 . No Signs of Corrosion in Agent Cylinder 7 > 3 , 3 . ( 2 ) i Non - pressurized ) • 3 , 6 M Distribution Piping Unobstructed and Contiguous 7 , 3 , 3 . 1 ( 3 ) K 3 , 7 : lint Nozzles are Correct , Clean & Properly Aimed 7 . 3 . 3 . 1 ( 2 ) 3 . 8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7 . 3 . 4 1 i ` Fixed -Temp ( Other Than Fusible Metal Alloy Type ) & 3 . . M 7 . 3 { 5 iatiomoswassvos . , . n. Heat Detectors Maintained or ReplacedA lit Auxiliary Equipment Such as Water valves 3 . 10 MFunctioned Correctly 7 . 3 . 3 . 1 (2 ) jil ji l----11 ' 3 • 11 l\tt Internal Maintenance as Required by Manufacturer Title 19 * 904 . 7 N D -- Deficiency C = Comment ( IndicateI , , . . . l . : . . . : i:>3 .• ` '•y:: . • b5:• rr. Y • r`•4 �tg: II II �I . . . . . . . - • ; � >.�.\• r�r>a Yoa 2 - r r Yr • ) t J w £�ti�' . . _ _ > € " ;�`. > w cienc e ' • T,. x < s $ ,:. Y ar is ti a \ , , if # v. i. i� : slit devices { < . J v>l: :.:{ ,.C{:9i: - _. Y. ' Skb ,t�,+ S£ • 4 Fn1. I . F ..,cw...wbLaiddeci,dpM r! W ..W<Kr.•%•.+zk:Et..oCtl.C:<4.♦w.Waeec-• : .. ...::.. '.. . - : . . . . , . . . � . : ... {,. . . . •. . . . • ' 4:4 • . . Ah{,+v .cV%t % m• �f+.• .vWr6rri}:. :Yn�..V�.a.��s 1hc'dYW I • 1 I_ I ml 9 *WO ...W '.I..:.:+:. .. . . ' . . 'eY.sSW10b»: . : . . �. �IlY ill l • IIII�ll).h � . �l�Yl ! � ii � � i ilb �bll llil II i ep • • e - L. -JI I a 1 • . 22iIlllllllllllll I O 111 li ii 111 I 1' I +, :.,. : . .n n. .r. , . . . . . . elMl . dal 4 . .W 11411d84N� ld I . { 8 .: .. i # Check here it additional Deficienc ies and Comments are listed ilted on Form AES 9 . Number attached : .. v.,•i See Correction Form AES 10 for corrected deficiencies . Num. ber attached : , . . . . . . �. : , .: . . . . , . , , ,wiMi• ,waliw 1 hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this dare 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 forms • Print Nameil Signature • .t / Date a "2 7 -"A , Form AES 20 Sept. 33 2013