HomeMy WebLinkAboutFAI18-0002 031-172-082 Thermalito Union School Dist.-Plumas School-Thermalito-2023-7KS r e emical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual }
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<:"Oire Extinguishing System Inspection,Testing,and Maintenance Report :i
Property Information ��0 `op►�+ Contractor or Licensed Owner Information
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(Building Namef' 0.y,'.C.5 j cyNZ,a 1 a i Name Wilgus Fire Control Inc.
`' I,q 4544 Mountain Lakes Blvd.
(Address �-{t-{ 0 r�t/,,,yv�5 f� ucL ������ ddress
( ARE �Pe-^ (City Redding St. CA Zip 96003
(City�h�t�k t; -Irb ILicense# ~ 462979 {Phone 530-241-2465
(Contact Person -ti b lJ 1 ❑ SFM IJob# (Q Lc 5 a
'Phone `l l '2 p L p 0 I ® CSLB IMisc.
System Information • • _....,...........1.,,,,,..„...,
Cylinder Size 'g C;ta ID i, Last Hydrostatic Test Date Zv 2 Z Flow Points Capacity Used
(System Location ' i,,,_\L.,k,, System Mfr. �S<.%A1._ Model# +0..�- i f)Z-
IFuel/Heat Shut Off: - -
ectncal# ✓ Integral Make Up Air Shut Down >�
(Gas# / i Electrical Total
Nozzle- ► • 1 10 ,• - Flow Points
Items 4 #of Items. t`..�`. Dimensions Model ! '1•,2 •,rr- �(at z1
(Hoods I 1 16 P :.A, + I I 1 I a,r, , I
(Plenums I l I 4 r I t I�J
[Ducts I t 12 3" K i'" I I. t. .) I 1. I \ I ‘
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Nozzle Nozzle 7. '5liotal '„' '- • Nozzle ` Nozzle I Total
Appliance Name - ( App lance Name Irtode( Flow •Points Flow Paints
Model Fiow Ppitsts f 1gw.Rols�ts
[ c_.Lr; z" 11 L ,._ II I I
I I[ '1'
I I _ II
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Fixed ITemperature Sensing Elements
(Such as Fusible Links)
Quantity ( Tem 1::: ,: DafteK � �Date`
'=_ . . _ . ' F''' Install
� I", fl �;� t� Date
:,.._. - :.. . ::: a -. 1,
fz- I 2-)2b I -7 - 17- 23 i I I I I
I I I . I -
Inspection,Testing, and Maintenance ,..7 •,:j,,...`;,a
P=Pass F=Fail N/A=Not Applicable
I Inspection T Test M Maintenance _
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p , ll p� 3Only P,F,NIA
Desc on
MVP�?' r;'. ,?a'.. f%{�r-, c�� �6r's �'..,.`�.�.t , u flR1I rQ c i .afc ?e '. .: .. ..
1 1 I Manual Actuators are Unobstructed 7 2 2(2) '7- 23
(i.e. Remote Pull Station' 17 n
1.2 I Tamper Indicators&Seals Intact 1 7.2.2(3) 1 j I l
1.3 1 Maintenance Tag in Place I 7.2.2(4) l 1 —
Title 19$906 ''I _
1.4 I No Obvious Physical Damage I 7.2.2(5) 1 1 !_.._�
1.5 1 Gauge Readings within Proper Limits I 7.2.2(6) I 7 Njk_
(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 \ e
Hood,Ducts&Protected Cooking Appliances Have 1 7 2 2 8 I I
1.8 I Not Been Replaced.Modifier+or Relon ted ( ) e'
2.1 T {Automatic Detection/Manual Actuation Functioned I 7.3.3.4 Y I. P
{Correctly I
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' r , - hemtcal Pre-Engineered California Code of Regulations-Title 19 Semi-Annual 2 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
Property Information ,�F OF CA�r�Qt, Contractor or Licensed Owner Information
'I•�I
(Building Named imMp,� J CAN DD ("'('` r Name Wilgus Fire Control Inc.
(Address 1440 etuv►'�g5 A U Q. - rr ,4\ f v f Job# 366 So
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I�cityi te,'f'L� ''rzt --
inspection, Testing,and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
item:, x r ° $' t .' I ._ ;.`% .t•I:',f°fir " �,, _. (-.v1u1>h ..4.:) Its' I P,F,N/A.
2.2 I T Fuel Shut-Off Operated Correctly 7.3.3.4 I z-(7-231 1 .2
2.3 I T Regulator Tested&is within Acceptable Limits 7.3.3.4 I I I P
12 4 1 T Manual Reset Relay Functioned Correctly 7.3.3.4 I l I P
(If Applicable)
3.1 I M All Agent Containers within Acceptable Hydrostatic Test Dates 7 5 1(1) I ` I P
3.2 I M {All Auxiliary Pressure Containers andlor Hose 7.5.1(2)(3) ' y 1 pt-
ssemblies within Acceptable Hydrostatic Test Dates
3.3 I M Cartridge Weights within Acceptable Limits 7.3.3.1(2) 1 1 I I P
3.4 I M Liquid Level within Acceptable Limits 7.3.3.1(2) I ` I I A
(Non-pressurized)
3'5 I M No Signs of-Corrosion in Agent Cylinder 7.3.3.1(2) y ( I
(Non-pressurized) I 3.6 I M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) I I I I ,_n
3.7 I M Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) 1 , I I P
3.8 I M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 I I I I'' P1
3.9 I M Fixed-Temp(Other Than Fusible Metal Alloy Type)& 7 3 5 I ` I 'N(P
Heat Detectors Maintained or Replaced 1
3.10 l M Auxiliary Equipment Such as Water valves 7.3.3.1(2) I I C3`A
Functioned Correctly 1 .�-t -' I I
3.11 I M Internal Maintenance as Required by Manufacturer Title 19§904.7 I ' I I P
D=Deficienc C=Comment (Indicate pe
Item Date Riser D C . Deficiencies and Comments
indicate all equipment,devices and parts that were repaired or replaced .,_ _.
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t:ICheck here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
0 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 90/to 906 and that the equipment is fully operable
except as noted in the"Deficiencies and Comments"section of this form.
Print Name me,(( Lp_._. �l
ISignature 9�'X „�Ci IA— � _ Date '7_ ('7- Z 3
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