HomeMy WebLinkAboutThermalito Union School Dist.-Nelson School-Thermalito-2023-7KS et Gtremical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual
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Fire Extinguishing System Inspection,Testing,and Maintenance Report ,...._..: . .. i
Property Information •ctj Contractor or Licensed Owner Information
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Building Name 0-5QS Dv\ C.AL o k 'Name Wilgus Fire Control Inc.
'Address 2 2 5s tp-Ba >4o � /� (Address 4544 Mountain Lakes Blvd.
µA¢ 'City Redding St. CA Zip 96003__1
1City 01,4q..{n 1 ;4 3 [License# 462979 (Phone 530-241-2465
'Contact Person el nde 4 ) I ❑ SFM (Job# ';-Ql0_;'-I .. ...
'Phone Js" 3 z,q62 a I ® CSLB JMisc.
System Information
__.
Cylinder Size- , nQ 11, Last Hydrostatic Test Date D b Flow Points CapacityUsed _
(System Location f 1JG„ t System Mfr. c(` if i_
(Fuel/Heat Shut Off:
{Gas# Electrical# Integral Make Up Air Shut Down
n out s NOVI .;� . 3 ,J ,�.7 r I Total
is iil I l� �r,. r ,e i4, s. ,' `Model# I A' Flow Points: Y i' A., r ,. _% Flow Points
Hoods .w,.- • -,tr.;:, tu,_.. _. .. . ,�r u�� � I I__
(Plenums 1 1 1 `1 I I t la i I C. 1 i 1 r
[Ducts I I I t Ll it X 'zY I r t .) I i Ic,
I
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
' ,� Nozzle ,I Nozzle Total
Appliance Name Nozzle ( Nozzle rota(
Appliance Name
Pf? • Model 4 Flow Points Flow PointsModel Flow Points Flow Points
( tic,0-54" 4 ZS'" ,4- --- I % I 1
I SI I I —I
1 ! I
,
4 i 1I l I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
II r-sa It t Mfr' ( Install
t 1 t% , - 1 l ,,A4 . , 11 k `' *pate_j Date
c��f ,l+ ¢ 1,10, i Bad'--' • e 0,,„ -*, t�
L_-,?— Ca C t> )? 6 '7 -- 1 g -- 71 I I I I
: I I I II I I I
Inspection,Testing, and Maintenance _s-N' w`
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
'i�r� E lc i i,i;iii1,„ 1 8I... e e Ili► , 'a`!•'•' 1'sl`urar+ :Only P,F,NIA
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1.1 I 1 MMa.nual Actuators are Unobstructed 1 7 2 2(2) 7 , 7A P
I (i.e. Remote Pull Station' ('t
1.2 1 I (Tamper Indicators&Seals Intact I 7.2.2(3) - I 1 P
1.3 I 1 (Maintenance Tag in Place I Title 19($906 l I - — P
' 1.4 I 1 INo Obvious Physical Damage I 7.2.2(5) 1—
1 5 1 Gauge Readings within Proper Limits I 7 2.2(6) I ` IV !
(Stored Pressure)
1.6 I l (Blow-Off Caps in Place&Undamaged I 7.2.2(7) I I -
1.7 I I ,Hoods,Ducts,Filters in Place and Clean I CFC 904.11.6.3 I I r I
1.8 I
Hood, Ducts& Protected Cooking Appliances Have
I !Not Been Replaced.Modified or Reinr,atid I 7.2.2(8) I \ I P
2 1 I T [Automatic Detection/Manual Actuation Functioned 7.3.3.4
tCorrectlu I 1 1
c ... AGO+1('
ill .I I-.+. r r . + f �1 � +�� � i �..f � '1 � , '.Y. I I
-,.-Fire Extinguishing System Inspection',Testing,and Maintenance Report
Property Information ���� Contractor or Licensed Owner Information
� 9y+r�1
(Building Name 4,k 5 ' C�DD 1 � D1 iName Wilgus Fire Control Inc.9 ...)
'Address 2.2..65 (9 t` j Q-- • \,_ os's. 'Job# '�Kv/n Imo, 1
I
z-
Inspection,Testing,and Maintenance
=Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Itemit
` '_ . -. Del; t >. r:- ' . rip e :re .e r; r 1`t_t , . r =Q�iy P1F N/A
1
2.2 T 'Fuel Shut-Off Operated Correctly 7.3.3,4 7_/ii Z3J I e
2.3 T 'Regulator Tested&is within Acceptable Limits 7.3.3.4 I P
2 4 T Manual Reset Relay Functioned Correctly 7.3.3.4 1 I 1 (If Applicable) 1 P
3.1 M All Agent Containers within Acceptable Hydrostatic 7 5 1(1)
Test Dates
3 2 M ll Auxiliary Pressure Containers and/or Rose 7.5.1(2)(3) ' , IKII A-
ssemblies within Acceptable Hydrostatic Test Dates
3.3 M `Cartridge Weights within Acceptable limits 7.3.3.1(2) ` f
3.4 M ILiquid Level within Acceptable Limits 7.3.3.1(2) Q
(Non pressurized)
3.5 M INo Signs of-Corrosion in Agent Cylinder 7.3.3.1(2)
y `
(Non-pressurized) _
3.6 M 'Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) , ' p
3.7 M 'Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) P
3.8 M `Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 ' ' l
(Fixed-Temp(Other Than Fusible Metal Alloy Type)& I, /
3.9 M Heat Detectors Maintained or Replaced 7.3.5 �J(
Auxiliary Equipment Such as Water valves
3.10 M 7.3.3.1(2) .` `` /�
!Functioned Correctly 1 II r IN
3.11 M 'Internal Maintenance as Required by Manufacturer Title 19§904.7 4
D=Deficiency C=Comment (indicate +e)
Item Date Riser D ' C Deficiencies and Comments
=; :f...____:...:. htdicate all equipment,devices and parts that were repaired or replaced
III
III
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1 I 1
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(Check hese if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
I_) See Correction Form AES 10 for corrected deficiencies. Number attached:
1 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 6,,,s- ina. tom-
ISignature P r>� l"--j Date '7.-1q.— Z 3
r -
Gn.... ACC'fin