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HomeMy WebLinkAboutFAI21-0019 078-170-063 CF Ansul Church Of The Nazarene-Oroville-2023-9 KS 1Ne ", hemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual 1 of 2 lire Extinguishing System inspection,Testing,and Maintenance Report o .&��t Property Information •c0j 4) I Contractor or Licensed Owner Information 1. 'Building Name fll� IsJ CIA Lta_ch ////vco -i Name Wilgus Fire Control Inc. 'Address L Z 3$ tevk mkte-0 ;15 0. 1je,..,`___,/P, 'Address 4544 Mountain Lakes Blvd. I E MP- 'City Redding St. CA Zip 96003 'City ©(Lb U%' 1.1 Q_ 'License# 462979 'Phone 530-241-2465 'Contact PersorrTlp50. I 0 SFM IJob# 3 is(,, 54 'Phone g 3-6- .744 ta.� I ® CSLB lMisc. — - .em Information Cylinder Size' Gt c,( (e n Last HydrostaticTest Date Zo 2 z Flow Points Capacity Used (, - I System Location WO. II System Mfr. A-t,\G i t ) Model# fa- 1 fry Z- Fuel/Heat Shut Oft --- ' - 'Gas# 1 // Electrical# Integral Make Up Air Shut Down ;�' n.= -- 1 . ; Total I4 , e $ I 174.1. ,r g ', I tl11-)Cf,E 1 ':� -.. - z - -_ '' , 'I. u 1 c M a �tM •-_� �� . . � : , :: 4t �, - ,� .�.ta __. ... ` Flow Points 'Hoods I I - to ' X. 'Plenums I I 1 f o' X R I i i‘; I 1 I l I L 'Ducts I t 11.5 x M. I i c+:) I ( I 1 I \ Cooking Appliances Left to Right with Sizes and Coverage Nozzles o; Mal r pi ne�tr,�4 I , Nozzle Total ,,r1 a.i a•'t I ,ref , pn ; Ioo��r, Olsten, ' ', ,a, ,.�1 s I ;t.-. •"el, IFlowPointsIFlowPointsI C. tzddle_ I I N r t I I I I ''-- I--►- I I I - I I — 1 I — II I I - .�_____I I --- I I • I I -- I I I ! Fixed Temperature Sensing Elements (Such as Fusible Links) A i 11Afr4 '�+1, :t �' -i - Install T a- I ,i 'all q r ) a i€ a - t7 . -. a ' K 1 it. 0. t k 'Date. Date 1 173C2d 12cz.D 9 - t-3- .7�3 rI . I I I I I ' J " II I I Inspection,Testing,and Maintenance } I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable Ile . CI° +�. '�"' < Ros p t1 k �„. +,aa ... r � }^!,�'�a1 . Only I P,F,N/A l .f efereric` ,l, ,. 4. �., . 1 1 I I (Manual Actuators are Unobstructed 7 2 2(2) (i.e. Remote Pull Station) -13"Z3I 1.2 I I (Tamper Indicators&Seals Intact 1 7.2.2(3) I ( I I P 1.3 I I 'Maintenance Tag in Place I 7.2.2(4) I I I P Title 19 006 _ 1.4 I I INo Obvious Physical Damage I 7.2.2(5) I / I P 1.5 I 'Gauge Gauge Readings within Proper Limits 7 2 2(6) /� (Stored Pressure) 1 I (1 I NO 1.6 I I IBiow-Off Caps in Place&Undamaged r 7.2.2(7) I 1 I P 1.7 I I (Hoods,Ducts,Filters in Place and Clean 1 CFC 904.11.6.3 I f 1 I l 1.8 I Hood, Ducts& Protected Cooking Appliances Have 7 2 2(8) Not Been Replaced Modified nr RPlor:ated • I P 2 1 T utomatic Detection/Manual Actuation Functioned 7.3.3.4 '- 'Correctly 1_ I I - - 1 r, i' I . - : a - :.a • s psi . $ • 4 .4 . . I' a -. i . • ..• - VIiII - Fire Extinguishing System Inspection,Testing,and Maintenance Report Property Information ,�rc�F CA�r'c011 Contractor or Licensed Owner Information r4 - 91trj 'Building Name Q(LIB Z C� a...� v J Name Wilgus Fire Control Inc. 1 'Address 225s- mint,+e_ U i5t0• � �,�,.2•J IJob# mil' I -4 1 'City 19e.OtJi tt � _tii,- Inspection,Testing,and Maintenance 1 I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable r z i°i. ff..�,t't-Yil i " -_., E e :Ci Ili I P'y,N1Ar I Item I I 1 2.2 I T 'Fuel Shut-Off Operated Correctly 1 7.3.3,4 }j. .( Z3 1 I P 2.3 I T ,Regulator Tested&is within Acceptable Limits I 7.3.3.4 I ) I I P 2 4 T Manual Reset Relay Functioned Correctly I 7.3.3.4 I i 1 1 P I I (If Applicable) All Agent Containers within Acceptable Hydrostatic I 7 5.1 1 I I } 3.i ( M (Tet Oates ( ) 3.2 ti M {All Auxiliary Pressure Containers and/or Hose { 7 5 1(2)(3) ` ` y } 1 a [Assemblies within Acceotable Hydrostatic Test Dates I N 1 t� I3.3 I M ICariridge Weights within Acceptable Limits I 7.3.3.1(2) I } I I P 3.4 1 M 'Liquid Level within Acceptable Limits I 7.3.31(2) f I I I P (Non-pressurized) 3.5 I M INo Signs of Corrosion in Agent Cylinder I 7.3.3.1(2) I I I I P (Non-pressurized) 3.6 I M (Distribution Piping Unobstructed and Contiguous I 7.3.3.1(3) I I I I P 3.7 I M (Nozzles are Correct,Clean&Properly Aimed I 7.3.3.1(2) I 1 I f P 3.8 I M (Fixed Temp Fusible Metal Alloy Type Detectors Replaced) 7.3.4 I 1 I I Q ( (Fixed-Temp(Other Than Fusible Metal Alloy Type)& ' I '( f��� 3.9 f M 7.3.5 1 Heat Detectors Maintained or Replaced 3.10 I M 'Auxiliary Equipment Such as Water valves f 7.3.3.1(2) I I It-1 I Functioned Correctly / 3.11 I M 'internal Maintenance as Required by Manufacturer I Title 19§904.7 I Yyr/ I 1 P 0.Deficiency C=Comment (Indicate •e f Item a Riser D C Deficiencies and Comments . Dte ' indicate ail equipment,devices and parts that were repaired or replaced , ... __ -_ _ II II II II I 1_ I- II ❑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. IPrint Name ( $ W. VVI ue, ((a (Z ISignature I L. Date A-- , 3- 23 G.,...- Acc'III