HomeMy WebLinkAboutFAI15-0050 041-130-044 Butte College Hood Gym #2 6.24.24 Wet Chemical Pre-Engineered California Code of Regulations -Title 19 Semi-Annual 1 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
Property Information ;,��OF Caop.4F Contractor or Licensed Owner Information
'Building Name Butte College Campus Center r 1a i Name Voltage Specialists
(Address 3536 Butte Campus Drive +fii ____� t�� Address 370 Apple Lane
>> F �`=— City Paradise St. CA Zip 95969
ICityOroville 'License# 880862 'Phone (530)624-4514
'Contact Person Mark Allen I ❑ SFM 'Job#
'Phone 530 893-7590 I ❑■ CSLB 'Misc.
•ystem Information
Cylinder Size 1.5 Last Hydrostatic Test Date 2023 Flow Points Capacity Used 3
'System Location Back of unit System Mfr. Ansul Model# R-103
IFuel/Heat Shut Off:
'Gas# N/A Electrical# X Integral Make Up Air Shut Down X
Items #of Items Dimensions oz Nozzle Nozzle Total
Model Flow Points Qty Flow Points
Hoods -
'Plenums I 1 I I 1 n I 1 I 1 I 1
(Ducts I 1 I I 2w I 2 I 1 I 2
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
Appliance Name Nozzle Nozzle Total Appliance Name Nozzle Nozzle Total
Model Flow Points Flow Points Model Flow Points Flow Points
Self contained griddle unit 1 n 1 1
1
1
Fixed Temperature Sensing Elements
(such as Fusible Links)
Quantity Temp Mfr Install Quantity Temp Mfr Install
Date Date Date Date
1 450 2023 1 I I
I I
Inspection, Testing and Maintenance
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Item Description NFPA CA Date Comments Only P,F,N/A
ed.Referfer CA
1 1 I Manual Actuators are Unobstructed 7.2.2(2) 06/28/24 P
(i.e. remote pull station)
1.2 I I (Tamper Indicators&Seals Intact 7.2.2(3) 06/28/24 I I P
7.2.2(4)
1.3 I Maintenance Tag in Place Title 19 906� 06/28/24 I P
1.4 I I INo Obvious Physical Damage 7.2.2(5) 06/28/24 I I P
1.5 I I 'Gauge Readings within Proper Limits I 7.2.2(6) I I I N/A
(Stored pressure)
1.6 I I IBlow-off Caps in Place&Undamaged 7.2.2(7) 06/28/24 I I P
1.7 I I (Hoods, Ducts, Filters in Place and Clean CFC 904.11.6.3 06/28/24 I I P
1.8 I I (Hood, Ducts&Protected Cooking Appliances Have
Not B ' 7 2 2(8) 06/28/24 I I P
een Replaced, Modified or Relocated
2.1
I T 'Automatic Detection/Manual Actuation Functioned 'Correctly 7.3.3.4 06/28/24 I I P
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
OF Ca r.,N
Property Information :,sue ',p of Contractor or Licensed Owner Information
'Building Name Butte College Campus Center 'Name Voltage Specialists
'Address 3536 Butte Campus Drive 'j , �� IJob#
'City Oroville ', E R= I
Inspection,Testing and Maintenance
I = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Item Description NFPA Refer
CA I Date Comments Only P,F,N/A
ed.Reference
2.2 T Fuel Shut-off Operated Correctly 7.3.3.4 06/28/24 P
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 06/28/24 P
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4 N/A
(if applicable)
3.1 M All Agent Containers within Acceptable Hydrostatic 7.5.1(1) 06/28/24 P
Test Dates
3.2 M All Auxiliary Pressure Containers and/or Hose 7.5.1(2)(3) 06/28/24 P
Assemblies within Acceptable Hydrostatic Test Dates
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2) 06/28/24 P
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2) 06/28/24 P
(Non-pressurized)
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2) 06/28/24 P
(Non-pressurized)
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) 06/28/24 P
3.7 M Nozzles are Correct, Clean&Properly Aimed 7.3.3.1(2) 06/28/24 P
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 06/28/24 P
3.9 M Fixed-Temp(other than fusible metal alloy type) 7,3.5 N/A
&Heat Detectors Maintained or Replaced
3.10 M Auxiliary Equipment Such as Water valves 7.3.3.1(2) N/A
Functioned Correctly
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904.7 06/28/24 P
D=Deficiency C=Comment (Indicate type)
item mmummidmil Deficiencies and Comments
Indicate all equipment,devices and parts that were repaired or replaced
6/28/24 ✓ Unit not in use at time of inspection
Pin
i ui
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❑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 Don Cantrell
Signature I (90. Date 06/28/24
Form AES 20 Sept.3,2013