HomeMy WebLinkAboutFAI19-0018 CF Hood Suppression System 2022 Wet Chemical Pre-Engineered California Code of Regulations -Title 19 Semi-Annual
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# Fire Extinguishing System Inspection,Testing,and Maintenance Report
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Property Information ,���? Ci,�o�?, Contractor or Licensed Owner Information
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Building Name Z.�, '�e 6?-/ -U �� `{,�/ Name Wilgus Fire Control Inc.
Address ky (( DQ7 ie-61( G-Lvz,1 9j\ Ls-isz� Address 4544 Mountain Lakes Blvd.
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�t�Z.MP' City Redding St. CA Zip 96003
City (Pcc,;c.I <u License# 462979 Phone 530-241-2465
Contact Person Ppb ❑ SFM Job# _
Phone 5-gq--5gv, C.II 370 )2,' [ CSLB Misc. _
• - System Information ___
Cylinder Size (-', Last HydrostaticTest Date 2Qz/ Flow Points Capacity Used
System Location i. ,.`r,,' -- System Mfr. �9-e6 Model# 4 /0 2
Fuel/Heat Shut Off: ,X
Gas#44, Electrical# Integral Make Up Air Shut Down
Items #of Items Dimensions Nozzle Nozzle Nozzle Total
Model# Flow Points Qty Flow Points
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Plenums I ( I / � / �Z
Ducts I / I /SJ� 15 I 2, al .7 I / I :L
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
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I I II I I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity Temp Mfr Install Mfr Install
Quantity Temp
Date Date Date Date
Inspection,Testing, and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
Item Description NFPA 17A GA Date Comments Only P,F,N/A
ed.Reference
1 1 I Manual Actuators are Unobstructed 7 2 2(2) p
(i.e. Remote Pull Station)
1.2 I Tamper Indicators&Seals Intact 7.2.2(3) P
1.3 I Maintenance Tag in Place 1 7.2.2(4)
Title 19 0064_____
1.4 I No Obvious Physical Damage 7.2.2(5)
1.5 I Gauge Readings within Proper Limits 7 2 2(6) /(/`
(Stored Pressure) !�
1.6 I Blow-Off Caps in Place&Undamaged 7.2.2(7)
1.7 I Hoods, Ducts,Filters in Place and Clean CFC 904.11.6.3 ,
Hood, Ducts& Protected Cooking Appliances Have )
1.8 I Not Been Replaced,Modified or Relocated 7.2.2(B
2.1 T Automatic Detection/Manual Actuation Functioned 7.3.3.4
el
Correctly
Form AES 20 Sept.3.2013
Wet`Chemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual
Fire Extinguishing System Inspection,Testing,and Maintenance Report 2 of 2
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Property Information c�/��.pt?, Contractor or Licensed Owner Information
,� y , y�C° a 9vY Name Wilgus Fire Control Inc.
Building Name to 04,c D l
Address ll400'"`f�'"rele )0/ A e.� �F.av° Q Job#
City Orb e—J/� �t �t= MP
Ilil_lti on, Testing,and Maintenance
I = Inspection T =Test M= Maintenance P=Pass F=Fail N/A =Not Applicable
NFItem Description fer CA Date Comments Only P,F,N/A
ed.R
_ ed.Reference
2.2 r Fuel Shut-Off Operated Correctly 7.3.3.4 P
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 /WA
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4 TIN
(If Applicable) TI��
3.1 M All Agent Containers within Acceptable Hydrostatic 7 5.1(1)
Test Dates
All Auxiliary Pressure Containers and/or Hose 5 l'
3.2 M Assemblies within Acceptable Hydrostatic Test Dates r'o'1(2)(3) , —/
3.3 M Cartridge Weights within Acceptable Limits 7.3.3.1(2) r�
3.4 M Liquid Level within Acceptable Limits 7 3 3 1(2)
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(Non-pressurized)
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2)
(Non-pressurized)
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3)
3.7 M Nozzles are Correct,Clean& Properly Aimed 7.3.3.1(2)
3.8 M Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7.3.4 f
Fixed-Temp(Other Than Fusible Metal Alloy Type)& n
3.9 M Heat Detectors Maintained or Replaced 7.3.5 �III�.C�
3.10 M Auxiliary Equipment Such as Water valves 7.3.3.1(2)
Functioned Correctly r���+
3.11 M Internal Maintenance as Required by Manufacturer Title 19§904.7 tit
D=Deficiency C=Comment (Indicate type
Deficiencies and Comments
s f lrikdithao),A.,,,,iii: Rier D C trtdicat"alleguipnrerrt,devices and parts That v ate repairer)or replaced
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Check here if additional Deficiencies and Comments are listed on Form AES 9. 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 ` f` `,i 'I 1, 4 I,
Signature Ilk,Al
rwi Date / �2. --,zi
rnrm AFS 20 Sent.3.2013