HomeMy WebLinkAboutFAI18-0012 065-110-058 CF Ansul 2023 Wet Chemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual 1 of 2
Fire Extinguishing System Inspection,Testing,ande Maintenance Report
Property Information �,`�° 'fio Contractor or Licensed Owner Information
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(Building Name'-304<„ Co, i'Ott-6,44te.a- , 1 Xa. Name Wilgus Fire Control Inc.
Address(p0 go 'ry,f(T � 1��
G ,,` .4." Address 4544 Mountain Lakes Blvd.
RE µg` (City Redding Si. CA Zip 96003
'City Jv(a.gal r4 'License# 462979 (Phone 530-241-2465
'Contact Person —0 %(. I [D SFM 'Job# `36, 6, q _,,,„,,____ ._.__..___
Phone
S "' qi 7 '3 c L 31 0 CSLB 'Misc.
System Information _ � � :.
Cylinder Size'30a( 0-n X Last HydrostaticTest Date ' v t '3 Flow Points Capacity Used I °-,
'System Location ' 1,,,a I( System Mfr. A-?.T'1 o L.- Model# t - I b 2_
Fuel/Heat Shut Off: u
'Gas# . . Electrical# ,e- Integral Make Up Air Shut Down ./
."'' Total
n
a e s i �t *,* '�'%` c
��1 ', . .�"a�,,`� '� � � t r�•' "�. 8< ,,o a na.Qi ,. Flow POIntS
'Hoods �- 'X �
'Plenums I I9' gat I i 4J` I I I - I -2._
'Ducts I Z I i'liz x CZ- 11 (•J I 1 I Z', I 2—
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
� ,� r i�k t `s`` ,,,. QZzle Total
Iz ry b is f I�o li n� me ''I 1 � �frlow Points I Flow Points
fn,t+ d d(4- 1 tl 1< z'f Z of 4 2 i.- I I I I
F8mai tco_ it x 2c t tJ I i I t,. I I I _
I I-a u LA. 1 4 u i- A e I 2- I --. I I I _ .
IQaha4 36 X 2 to Z X 2. o I "Z_ I I I
1u*-wen_ 14rcIC' iIQ I I I 7-- I I I_ I I
1.
Fixed Temperature Sensing Elements
(Such as Fusible Links)
���•.: s S , i ., =,-.,, a v,, ,, I Install
1's 1. t '', k .' . a'` h - . ' i p i e� ,w ' - '
t. � .�� �t�s 3k � `e �¢ �,� ' .:i � ���� • ..;'t������� a �(�sS� ° „ 4'�. ,s:te �.. I Data
c I qC6 II-0-2-0 c- i 2-2 '' I I I
I I I _
I I I I I __)
Inspection,Testing, and Maintenance y x
i =Inspection T =Test M=Mainienanr•.e P=Pass F=Fail N/A=!Vol Applicable
loti
� g .z :2+ . ,�Ta. t 7�'�r'�` a a b.a x s �+ ! • ' - s ' �'
, �� , ( l x 7 r. t, s 1 g�a , P,F,N1A
Manual Actuators are Unobstructed
1.1 i I (i.e.Remote Pull Station) I 7 2 2(2) I't 2. Z3 I I)
I 1.2 I 'Tamper Indicators&Seals Intact I 7.2.2(3) 1 I I t
II
I 1.3 I (Maintenance Tag in Place 7.2.2(4) (>
Title 19 0906 _{C"
i
1.4 ( I INo Obvious Physical Damage I 7.2.2(5) I I
1.5 I Gauge Readings within Proper Limits I 7 2 2(6) l -) A
I(Stored Pressure) `___.._
1.6 ( I (Blow-Off Caps in Place&Undamaged I 7.2.2(7) I I I
1.7 I (Hoods,Ducts,Filters in Place and Clean I CFC 904.11.6.3 I I �_ _ __
1 B I (Hood,Ducts& Protected Cooking Appliances Have 7 2 2(8) I Not Been Replaced.Modified or Relocated
�utomatic Detection/Manual Actuation Functioned
2.1 T !Correctly 7.3.3.d I
c,..... ACC on Co.,, 1 ',nil
-Wet Chemical Pre-Engineered California Code of Regulations-Title 19 Semi-Annual 2 of 2
Fire Extinguishing System Inspection,Testing,and Maintenance Report
Property Information %�pP Cont
ractor or Licensed Owner Information
1
H ��rt
!Building Namear 6 I,.t a Ca, CC tt Cot- 47 Name Wilgus Fire Control Inc.
la
!Address LO(.t~40 li,j' Cu-F 1L.b R� �,`2�i Job# -3(.¢ c 1.4c.I !
!City Vil Qc)cx (t'ck yMR� I
Inspection,Testing,and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
Item . a,i jilt'14 iti.. .._ c arl,! 1 .t (�i. e. I
'ital. � i� IA
2.2 T !Fuel Shut-Off Operated Correctly 7.3.3,4 5-)z. 2,3 e ? o
2.3 T 'Regulator Tested&is within Acceptable Limits 7.3.3.4
2.4 T 'Manual Reset Relay Functioned Correctly 7.3.3.4 I P 3.1 M !Tel Agent s Containers within Acceptable Hydrostatic 7.5.1(1) I I P
V3 2 M Auxiliary Pressure Containers and/or Hose 7 5 1(2)(3) ( ( esemblies within Acceptable Hydrostatic Test Dales
3.3 ( M 'Cartridge Weights within Acceptable Limits 7.3.3.1(2) 1 I #
3.4 M Liquid Level within Acceptable Limits 7 3 3 1(2)
I (Non-pressurized) I !
3.5 I M INo Signs of Corrosion in Agent Cylinder 7.3.3.1(2) I I P
(Non-pressurized)
3.6 M 'Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) I I P
3.7 M 'Nozzles are Correct,Clean& Properly Aimed 7.3.3.1(2) I I 9
3.8 M 'Fixed Temp Fusible Metal Alloy Type Defectors Replaced 7.3.4 11 P
(Fixed-Temp(Other Than Fusible Metal Alloy Type)& I I i�j
3.9 M pt
Heat Detectors Maintained or Replaced 7.3.5 t
13.10 ! M 'Auxiliary Equipment Such as Water valves 7.3.3.1(2) I I + },(tt
Functioned Correctly }
3.11 M !Internal Maintenance as Required by Manufacturer Title 19§904.7 I P
0=Deficienc C=Comment Indicate .e
Item Date Riser D C Deficiencies and Comments
ind,cate ail egii prnent devicr;s and p:uts fat r.ere repaired or replaced
I
iiimoi
I1
1_j Check here if additional Deficiencies and Comments are listed on Form AES 9. Number attached:
Li 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 f,,n. JAI#A,L t'L t'L—
I Signature I � j Date ' r 2- 2 5 I