HomeMy WebLinkAboutFAI15-0059 030-071-015 Thermalito Union School Dist.- Poplar School-Thermalito-2023-7KS i ,"hemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual
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Fire Extinguishing System Inspection,Testing,and Maintenance Report .
Property Information �'toT ---•0 �� Contractor or Licensed Owner Information
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'Building Name Q�n IQ2 Sit p 1 Name Wilgus Fire Control Inc.
Address 'ZEj Z .Pen lap_ proQ, 9\� /�� Address 4544 Mountain Lakes Blvd.
` �EMA. 'City Redding St. CA Zip 96003
(City t (host-i'^-1 I;+n 'License# 462979 IPhone 530-241-2465
(Contact Person At..3tp_atz I E] SFM !Job# '36%O ‹- _ __.__
!Phone •7 i 2 - O 1.0 p I ® CSLB 'Misc. _____J
System In'. ' . , v „As _,
Cylinder Size `.j q p�I I niN Last Hydrostatic Test Date -Z O 21 Flow Points Capacity Used
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(System Location ( a_t I SIistem Mfr. V-N c t A.t-- Model# ,I-1- t 19 2,-
IFuellHeat Shut Off: ;
(Gas#/ t t ( Electrical# / Integral Make Up Air Shut Down -
••� Total
i em zi.* a '4-a4,: s lte3 t." ?1tm °.,, . �4:-I-,, `'� ..,; ' � T -V 01 i• i �'. s M T'.. Flow Points
'Hoods I 1_ 1 g't Y at '?. 1
'Plenums 1 I 1W 1 - II_ (,J 1 1 I l I
'Ducts I 1 It5" x l2'` I i! 5,1 I 1 I ! l
Cooking Appliances
Left to Riaht with Sizes and Coverage Nozzles
I4It" o ants • ... _ L:FIflS Flow Points
L-1''1-t t X. 2' X. Z 1 5 I 2- 1 /� 1 1 I 1
I 1 1,
I I J I I � I I
I I I II I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links) Install 4 r l - d
3:1° '� i- rf -lii" •,-1� 1 t °VLk,i .lip #{ . . of• _ Dale
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,7--- 4-4.S n 20 2�- 1 G'- ?3 I I I I I
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Inspection,Testing, and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fait N/A =Not Applicable
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le 1' �I . '"e�- .e' l Ili :• @ft3 . , l II,_ . ..0 i y
Manual Actuators are Unobstructed 7 2 2 2) /C('
1.1 l I (i.e. Remote Pull Station' ( 2I
1.2 I I Tamper Indicators&Seals Intact 1 7.2.2(3) 1 t I I
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1.3 I 1 IMaintenance Tag in Place 7.2.2(4)
Titre 19 006 I I _ - ��----
1.4 I I INo Obvious Physical Damage 7.2.2(5) I I r j
1.5 , 1 Gauge Readings within Proper Limits 7.2.2(6) I n tft
(Stored Pressure)
1.6 I I IBlow-Off Caps in Place&Undamaged r 7.2.2(7) I _
1.7 I I (Hoods,Ducts,Filters in Place and Clean CFC 904.11.6.3 l I Q_
1 8 I I 'Hood, Ducts& Protected Cooking Appliances Have I 7 2 2(B) I /(� P
Not Been Replaced,Modified or Relocntpri
1 T (Automatic Detection/Manual Actuation Fu inctioned I 7,3.3.4 I I. e
2 1 I
Correctly .
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Fire Extinguishing System Inspection,Testing,and Maintenance Report
Property Information `�dF Contractor or Licensed Owner Information
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!Building Name pD n`Qg__ e-,, n l tia 1' Name Wilgus Fire Control Inc.
!Address 228 1 Pfv.(r oz., 4r J I rr4\,,,MP r Job# 3 (o (o g2—
Inspection,Testing,and Maintenance
1 =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
item .xr- s5 e f.I my, P,F,N
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•�++�., 9' J i ( �.• 9 gip, < , �*/,,q}l, .,,.
' ."i@+a 4 •♦.t�':� „_-1.:!4_ _ . 1. -�.. T tS. & s "'rf"'Y.
2.2 I T !Fuel Shut-Off Operated Correctly I 7.3.3.4 17-(C_Z31 ! P I
2.3 I T )Regulator Tested&is within Acceptable Limits I 7'3'3'4 I ) I I e 1
IN(If Appl cable Relay Functioned Correctly
2.4 I T 1 7.3.3.4 I 1 I I Y }
3.1 1
M IAII Agent Containers within Acceptable Hydrostatic 1
Test Dates 7.5.1(1) I f I 1 P 1
3.2 I M (All Auxiliary Pressure Containers andior Hose I 7.5.1(2)(3) I II ` W,SAI
�gssemblies within Acceptable Hydrostatic Test Dates
3.3 I M !Cartridge Weights within Acceptable Limits I 7.3.3.1(2) I I I I P
3.4 I M !Liquid Level within Acceptable Limits I 7.3.3.1(2) I ` I I e
(Non-pressurized)
3.5 I M INo Signs of-Corrosion in Agent Cylinder I 7.3.3.1(2) I ` I I C
(Non-pressurized)
3.6 I M !Distribution Piping Unobstructed and Contiguous I 7.3.3.1(3) I I I e
3.7 I M !Nozzles are Correct,Clean&Properly Aimed I 7.3.3.1(2) I II I I
3.8 I M IFixed Temp Fusible Metal Alloy Type Detectors Replaced' 7.3.4 I 1 I ! f
3.9 I M 'Fixed-Temp(Other Than Fusible Metal Alloy Type)& ( 7 3 5 I I I 14
Heat Detectors Maintained or Replaced
3.10 I M !Auxiliary Equipment Such as Water valves I 7.3.3.1(2) I I I I °(
Functioned Correctly
3.11 I M !internal Maintenance as Required by Manufacturer I Title 19§904.7 I I I e
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D=Deficiency C=Comment (indicate +a
Item Date Riser D • C Deficiencies and Comments
J N ... indicate all equipment.devices and parts that weto repaired or replaced , _.. _
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{, ]Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
[j See Correction Form AES 10 for corrected deficiencies. Number attached:
l 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 I 13 ev-N tfrl u, t e e-
Signature f'•1 riM"l ii,---k Date 't--R-- 2 3
C...... ACC'nfl