HomeMy WebLinkAboutFAI15-0006 063-210-021 CF SHI Wet Chemical Pre-Engineered California Code of Regulations -Title 19 Semi-Annual
Fire Extinguishing System Inspection,Testing,and Maintenance Report 1 of 2
of CA4/N,
Property Information %��� ��ib Contractor or Licensed Owner Information
Building NameFav-v5t �� � �IerSca ,� /nf Name HAYDEN FIRE PROTECTION
IAddressl 5 815 Cej - ore i; 41941
�� Address
7� 2515 Zanelia Way #5
�, _ City Chico St. CA Zipg5928
City ta-� 5-1- K ,Ltk.. License#� Q'-7/3r !Phone 1-800-417-0440 1
(Contact Person ❑ SFM (Job#
'Phone 530- S?j- 3( 5 4 - CSLB jMisc.
System Information
Cylinder Size t , C Last Hydrostatic Test Date a.a./ :: Flow Points Capacity Used
(System Location Mfr. /�} j 5r,it- Model#
l�i�CA'�*t+y Systemf:e` Cam
(Fuel/Heat Shut Off: tj.R,5
(Gas# f s Electrical# Integral Make Up Air Shut Down
Items 111 I #of Items E Dimensions I Nozzle Nozzle Nozzle ' Total
Model# Flow Points Qty Flow Points
Hoods I I `7 ' X '?'' I I I I
(Plenums I 17 'k o'l- I / I / I I
(Ducts I itotu k. tkti I ®2. c I .Z I I -2.
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name Nozzle I Nozzle Total
ApplianceNozzle Nozzle Total
Model Flow Points Flow Points Name Model Flow Points Flow Points
I I I II I I I
I I I II I I I 1
I I I II I I I
I II II I I i
Fixed Temperature Sensing Elements
(such as Fusible Links)
QuantityTempI Mfr Install i
Mfra ! Install
Quantity I Temp I Date Date
,9 h/Sc ' I c,2r,.-23 I ,o --P- 0)3 I I I I I
I I I II I I I 1
Inspection, Testing and Maintenance
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item - Description Inv I NFPA 17A CAI
pate omrnen s Only P F NIA
ed.Reference I
I (Manual Actuators are Unobstructed
1.1 O 7 2 2 2
(i.e.remote Dull station)
I `0_9 -,,)5 I
1.2 I 'Tamper Indicators&Seals Intact I 7.2.2(3) 1 I Y I I P
1.3 I 'Maintenance Tag in Place 7.2.2(4) 1
I Title 19 906� I 1 +
1.4 I INo Obvious Physical Damage — I 7.2.2(5) I I I ?
1.5 I IGauge Readings within Proper Limits I 7.2.2(6) 1
(Stored pressure) 1 I
1.6 1 IBlow-off Caps in Place&Undamaged 7.2.2(7) I I I I ,P
1.7 I 'Hoods,Ducts, Filters in Place and Clean CFC 904.11.6.3 I I I A"
1.8 I I Hood, Ducts& Protected Cooking Appliances Have 7 2 2(8} I I
I Not Been Replaced.Modified or Relocated
2.1 T utomatic Detection/Manual Actuation Functioned I 7.3.3.4 I \ I
Correctly l
Form AES 20 Sept.3,2013
Wet Chemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual 2 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
l Property Information �� p si Contractor or Licensed Owner Information
r 2'.t Name HAYDEN FIRE PROTECTION
,f/,' -9 It
'Building NameFpore,2 - l'e L. C�(f.�C/" ii'
'Address t 5 S`LS C-C,ive--(`f".-9R.j 41:1t�' / �i Job#
'City I& ./'R. — R.estA C;L.. a,,NE MP!=
Inspection,Testing and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item 'li escrlptiort;,, ON F,omMe` A
2.2 T Fuel Shut-off Operated Correctly 7.3.3.4 �120 P
2.3 T (Regulator Tested&is within Acceptable Limits 7.3.3.4 N 3 IQ
2.4 T 'Manual Reset Relay Functioned Correctly 7.3.3.4 I
(if applicable)
31 M 'All Agent Containers within Acceptable Hydrostatic 7.5.1(1) 1
Test Dates
II Auxiliary Pressure Containers and/or Hose 7 5 1 2 3 l Ui
3.2 M assemblies within Acceptable Hydrostatic Test Dates { ){ )
3.3 M (Cartridge Weights within Acceptable Limits 7.3.3.1(2) I I e
3.4 M (Liquid Level within Acceptable Limits 7.3.3.1(2)
i (Non-pressurized)
3.5 M iNo Signs of Corrosion in Agent Cylinder 7.3.3.1(2) I
(Non-pressurized)
3.6 M 'Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) I Q
3.7 M (Nozzles are Correct, Clean&Properly Aimed 7.3.3.1(2) I
3.8 M (Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 I I (-)
I3.8 M Fixed-Temp(other than fusible metal alloy type) 7.3.5
&Heat Detectors Maintained or Replaced
3.10 M !Auxiliary Equipment Such as Water valves 7.3.3.1(2)
' 1(1f{
Functioned Correctly
3.11 M 'Internal Maintenance as Required by Manufacturer Title 19§904.7 I 0
D=Deficiency C=Comment (Indicate type)
Item Date Riser D C Deficiencies and Comments
Indicate all equipment,devices and parts that were repaired or replaced
NIIIIIIIINIMmis
E Check here if additional Deficiencies and Comments are listed on Form AES9 Number attached:
[] 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 I I p,-
r 1
Signature ! j Date /9, 3
Form AES 20 Sept.3,2013