HomeMy WebLinkAboutFAI21-0019 CF Suppression Hood Inspection 3-2022 Wet Chemical Pre-Engineered California Code'of Regulations-Title 19 Semi Annual x -
. Fire Extinguishing System. •:Inspection,Testing,and Maintenance Report : rT s : : :
.,off c'\c2t Contractor or Licensed Owner Information
Property Information ‘�`�--`, , �o-Pfv,
Building Name 0 -O f ( (''''• 1L; Name Wilgus Fire Control Inc.
Address Z. Z 3 g 1'At;Y1 i--e_.... V ;Sf0. t gj`.• ���1" .,,Pl Address 4544 Mountain Lakes Blvd.
�11 RE MP City Redding St. CA Zip 96003
City e Q-0 V i at_ License# 462979 Phone 530-241-2465
Contact Person 14,0 (1Q4• ❑ SFM Job# '3(2 C2 E)G
Phone .,3-8 --7 44 La 4 ® CSLB Misc. —
_ _ System Inforn�atioq` -
CylinderSize ' cialtG" Last Hydrostatic Test Date 2-0 Z-a Flow Points Capacity Used (p
System Location l <L.l l System Mfr.11-1‘) L f✓ Model# g.- 1 o'Z _
Fuel/Heat Shut Off:
Gas# eS i // Electrical#)/`, J Integral Make Up Air Shut Down
Items #of Items Dimensions Nozzle Nozzle Nozzle Total
Model# Flow Points Qly Flow Points
Hoods % I*� i X `3'S. _ —_--
Plenums ( (u ' k' Q l iii t t. t
Ducts I ( i S K t V . I. v,-) ( ‘ l —
Cooking Appliances
Left to Riht with Sizes and Coverage Nozzles
Nozzle Nozzle Total Nozzle Nozzle Total
Appliance Name Appliance Name
Model Flow Points Flow Points Model Flow Points Flow Points
e et. e___- it F ( 3 _ — --
I I i
Fixed Temperature Sensing Elements
(Such as Fusible Links)
Quantity Temp Mfr Install Mfr Install
Quantity Temp
Date Date Date Date
I '3 [12o zc; z o 3 i7 ZZT1 —
1 =Inspection T =Test M=Maintenance P=Pass F =Fail N/A =Not Applicable _
NFPA17ACA
Item Description ed.Reference Date Comments Only P,F,N/A
Manual Actuators are Unobstructed -� 7.�
1.1 I (i.e. Remote Pull Station) 7.2.2(2)
1.2 I Tamper Indicators &Seals Intact 7.2.2(3) e _
1.3 I Maintenance Tag in Place 7.2.2(4) P
Title 19§906
1.4 I No Obvious Physical Damage 7.2.2(5) 1
_ _-
1.5 I Gauge Readings within Proper Limits 7 2 2(6) N I A
(Stored Pressure)
1.6 I Blow-Off Caps in Place& Undamaged 7.2.2(7) _ e
1.7 I Hoods, Ducts, Filters in Place and Clean CFC 904.11.6.3
Hood, Ducts& Protected Cooking Appliances Have 2 p
1.8 I Not Been Replaced,Modified or Relocated 7"'2(8) f
2.1 T Automatic Detection/Manual Actuation Functioned 7.3.3.4 1 p
Correctly
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tiYet Ciiemlcaf!Pre-En ineered California Code of Regulations-Title 19 Semi Ann at Z o �
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Fire Extinguishing System Inspection,.Testing,and Maintenance -Report, _.........................
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Property Information •�,`,pF C Contractor or Licensed Owner Information
Building Name e ill, wiXZ ` �� )5" Name Wilgus Fire Control Inc.
Address 2 Z 3 s `0-A.4-2.. V i Si.LA. tkP>F-�f et Job# j Liz Z2 09
City1,,'`7RE Nes
� ` tt -
'MR' ,OD 01a $1 vnd Maintenance �. .-_..
1 = Inspection T =Test M=Maintenance P=Pass F=Fail N/A =Not Applicable
NFPA`17A CA Date Comments OnlyP,F,N/A
Item Description
ed.Reference
2.2 T Fuel Shut-Off Operated Correctly 7 3.3.4 -?J i 7-u
2.3 T Regulator Tested&is within Acceptable Limits 7.3.3.4 P
2.4 T Manual Reset Relay Functioned Correctly 7.3.3.4 ,�
(If Applicable)
3.1 M All Agent Containers within Acceptable Hydrostatic 7 5 1(1)
Test Dates ^__
All Auxiliary Pressure Containers and/or Hose t I
3.2 M Assemblies within Acceptable Hydrostatic Test Dates 7.5.1(2)(3) {V f
3.3 M Cartridge Weights within Acceptable Limits 7.3 3.1(2) P
3.4 M Liquid Level within Acceptable Limits 7.3.3.1(2) P
(Non-pressurized) ,
3.5 M No Signs of Corrosion in Agent Cylinder 7.3.3.1(2) p
(Non-pressurized) 1
3.6 M Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) P
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 P
Fixed-Temp(Other Than Fusible Metal Alloy Type)& „ 1)
3.9 M Heat Detectors Maintained or Replaced 7.3.5 W
3.10 M Auxiliary Equipment Such as Water valves 7q A-
.3.3.1(2)
Functioned Correctly V .
3.11 M Internal Maintenance as Required by Manufacturer Title 19§§'904.7 P
D= Deficiency C =Comment (Indicate type)
" .
4 Deri'tciefCies attci Gommeiits r
. r lfiser.. tr I. C '_ _.a.�, ._,.. ll i men deviceesand a st at 0e •,or _ ---Y`,, i
lAd�cate� .eqn P I� a rf fi.._.k!�+�.�I. � :;;�•.
_)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:
I hereby certify that the fire protection equipment listed above has been fully inspected, tested, and maintained on this dale 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,,^ Vil. u.e,I( e-i/2_
Signature Date '3--( 7 - 2 Z_