HomeMy WebLinkAboutFAI21-0019 078-170-063 CF Hood Inspection .. .,,... ... . , ,.
illfetChernical Pre-Engineered - -California Code of Regulations-Title 19 Semi-Annual
it''''P'irei Extinguishing System ' --inspection,Testing,and Maintenance Report..,
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Property Information fr--74,. .-.O- /- '' .0 tb, Contractor or Licensed Owner Information
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Building Name eez, 1,,,3 a--z_ cA,,ktutel,,, Name Wilgus Fire Control Inc. 1
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Address 2'2 1 VV1,enktf— 0 1,4*ta.... "V\-:: -/A" Address 4544 Mountain Lakes Blvd.' , - v
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City Redding St. CA zip 96003
City Cip,,,,e9 0 i 1,14— License# 462979 Phone 530-241-2465
Contact Person —i-k Li_,,,,,C. El SFM Job# *"-"; ei.,6, 3 g i
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Phone 5 3-s -1 4-Li 4 gj CSLB ]Misc.
Cylinder Size Ct
c,t 15,..y\ Last Hydr Test Date 0 2...0 Flow Points Capacity Used (Q :
System Location (0. cd i SystenNfr. t....) , Model# (Zt o z 3
Fuel/Heat Shut Oft
Gas# 1 f i Electrical# N...-'''' _ Integral Make Up Air Shut Down 1
Flow Points
Hoods
,
Plenums L 10. ' v 8- t (..„0
( ,
iDucts I 6 YC7- L W. . ( i
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
014', , ;,,,,,,,,,,, ota,,441*,,tim,10 ,4, ...*%,....ifa lig l'eL10, t,44 ',3,,...14Pzzie Total 1
4 - - r -a,,,,iEt-otrt,-,o,ppwttvsk,r!aTRm 4,1 gjw4MOrl' -!`--,' ;,'Flow Points Flow Points 1 A A:.,..,_ _ ,..,:...t :.„„ HA. 2z2:?r222222222222-2t2-22-222 -,22, ,,,, ,,,,,,, , 4
t 9
,
i
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Fixed Temperature Sensing Elements
(Such as Fusible Links)
.1t,r,44. -7.1 -.i."z' Install
14W-41'n'litt*,: . ,1*-4,"., ,;,' "'-elet„'94:A.---0e$ - , '4A .,, ..40. -r,:=A*-,,,,,409trotarn'..,- .04-',TiOxi-v"1 1"0" kxt,.,4,',i,-V-
' -*,-,k4ii,`41*,,- - ' ,".„'#,,-vooWstir-eft' o jvrl. ' ,'"?' ,,,,,, ;4T,-.' ..4 .`,., .. gtRtS. ti: 1%.,, ., -k,-;,,,, c-....,--Av,..?„ .fili,.,,,,:%--, Date:,,,t.,,,ak 2,1,r. 2. -2•02„'22421turvit2-24,-N , , 2"242-2-24
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Inspection -Testirigi melltteltailee
1 .Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Manual Actuators are Unobstructed r -- ---7'---
1.1 I 7 2. -- „,,
2(2)
Remoteon)
. _27.2,3)
(i.e. Pull Station)
1.2 I Tamper Indicators&Seals Intact 7.2.2(3) P '
. ,
1.3 I Maintenance Tag in Place P
Title 19 4906
1.4 I No Obvious Physical Damage - 7,2 2(5) P
Gauge Readings within Proper Limits
1.5 I 7.2.2(6) -)I it
(Stored Pressure) 0•
1.6 I Blow-Off Caps in Place&Undamaged 7.2 2(7) . P
1.7 I Hoods,Ducts,Filters in Place and Clean CFC 904.11.6.3
1 ..
Hood,Ducts&Protected Cooking Appliances Have
1.8 I7.2.2(8) 0
Not Been Replaced,Modifiedor Relocated
2.1 T
Automatic Detection/Manual Actuation Functioned
7,3.3.4
Correctly ____
vitet.Chemical Pre.Engineered California Code of Regulations-Title 19 Semi-Annual 2 of 2
Fire Extinguishing System Inspection,Testing and Maintenance Report
CA444,14
Property Information - Contractor or Licensed Owner Information
417 -x,
Building Name 09_0 Name Ir Wilgus Fire Control Inc.
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Address 2, a s- m 0- 410,,,,(1. Job# 43a6 City
Or?R:1"r•M1?-11-trl"frIrit?''---•"' 2
-
- • inspection,Testing,and Maintenance
Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Itef0' ,l'`,-'.1***14.64.4tttgatv4totgle*.zefilf, fte.,44..-4N44
2 2 T Fuel Shut-Off Operated Correctly 7 3.3.4
- Pr
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4
Manual Reset Relay Functioned Correctly
2 4 T 7.3.3.4
(II Applicable)
All Agent Containers within Acceptable Hydrostatic
3'1 M Test Dates 7.5.1(1)
II Auxiliary Pressure Containers and/or Hose
3.2 M t. .1(2)(3) or
ssemblies within Acceptable Hydrostatic Test Dales
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2)
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2)
(Non-pressurized)
No Signs of Corrosion in Agent Cylinder 3,5 M 7.3.3.1(2)
(Non-pressurized)
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3)
3.7 M Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2)
as M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4
Fixed-Temp(Other Than Fusible Metal Alloy Type)&
3 M 7.3.5
Q/A
'9 Heat Detectors Maintained or Replaced
Auxiliary Equipment Such as Water valves
3 10 M 7.3.3.1(2)
Functioned Correctly
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904 7
D=Deficiency C=Comment Indicate pe
r D c 'Defialen.ale_s and C?mments
iucatatt equtpmevt cievatrs and vans mot wtto ropaireiCt f ephiceidJj
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Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
t 1 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 e-111
Signature
• Date z Z -3