HomeMy WebLinkAboutFAI15-0062 030-462-009 CF Ansul 2023 !r41 1-oo(..2. c)30 -yi,-2,--c1 cl
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 A�9 Ca 'cCi Contractor or Licensed Owner Information
(Building Name Roseleaf Oroville z' Name Foothill Fire Protection, Inc,
(Address 1900 20th Street r( -
:�`\� 'P Job# 29561475
(City Oroville t . M
97-
Inspection, Testing and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
2.2 T Fuel Shut-off Operated Correctly 7.3.3.4 P
2.3 T 'Regulator Tested&is within Acceptable Limits 7.3.3.4 IP
2.4 T 'Manual Reset Relay Functioned Correctly 7,3.3.4 IP
(if applicable)
3.1 M tAll Agent Containers within Acceptable Hydrostatic 7 5 1(1) IP
Test
3.2 M tAll Auxiliary Pressure Containers and/or Hose 7 5 1(2)(3) IP
ssemblies within Acceptable Hydrostatic Test Dates
3.3 M ICartridge Weights within Acceptable Limits 7.3.3.1(2) IP
3.4 M ILiquid Level within Acceptable Limits 7.3.3.1(2) IP
(Non-pressurized)
3.5 M INo Signs of Corrosion in Agent Cylinder 7.3.3.1(2) (p
(Non-pressurized)
3.6 M 'Distribution Piping Unobstructed and Contiguous 7.3.3.1(3) IP
3.7 M (Nozzles are Correct,Clean&Properly Aimed 7.3.3.1(2) IP
3.8 M 'Fixed Temp Fusible Metal Alloy Type Detectors Replaced 7 3 4 IP
3.9 M 'Fixed-Temp(other than fusible metal alloy type) 7 3 5 IN/A
&Heat Detectors Maintained or Replaced
3.10 M 'Auxiliary Equipment Such as Water valves 7.3.3.1(2) IN/A
Functioned Correctly
3.11 M 'Internal Maintenance as Required by Manufacturer Title 19§904.7 IN/A
D=Deficienc C=Comment Indicate t •e
Item Date Riser D C Deficiencies and Comments
Indicate ail equipment.devices and parts'that were repaired or replaced
TIE
ill V i Tank will be due for hydro in 2025
_.._._.Iri
L II[] ((PASS)
[
... II.
EilEI
El 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 'Morgan Olson
Signature I Date 5/12/23
Form AES 20 Sept.3,2013
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 4,00 j'rp. Contractor or Licensed Owner Information
Building Name Roseleaf Oroville ` -'41)3 1
9 -ci Name Foothill Fire Protection, Inc.
Address 1900 20th Street 94.-., � � Address 170 Erma Court
µ —" City Chico St. CA Zip 95928
City Oroville (License# 783132 IPhone (530)826-3013
Contact Person Diana Bingham I U SFM E-2555 IJob# 29561475
Phone(530)444-8511 I Li CSLB IMisc.
System Information
Cylinder Size 3 gal Last Hydrostatic Test Date 2013 Flow Points Capacity Used 8/11
(System Location Wall mt behind hood System Mfr. Ansul Model# R-102
Fuel/Heat Shut Off: Gas
!Gas* 1" Electrical* Yes Integral Make Up Air Shut Down Yes
�'a y �� ti� , .., - r vns- No /'10 ssy
Hoods 1 9' 1 F 1 5 5
(Plenums I 1 I 9` I 1 N I 1 ( 1 I 1
(Ducts I 1 I 1Ox14° I 2W I 2 I 1 I 2
Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
�1r h,�,d(J'r., � points
p F .,, nd / �.
�,.:a s . 0 Total
: Appliance Na �: �t
10 burner range 1 F 1 5 I
I I I II
I I I II I I I
Fixed Temperature Sensing Elements
(slf ch as Fusible Links)
Mfr 3•nstalt 1 Mfr (nstall
Ctu.ih.ty t Temp Ouank€ty Temp
Cate ,� ,, E.'; Date I Date
3 360 2 12,23 5/12/23
I I I I I I I I
Inspection, Testing and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F=Fail N/A=Not Applicable
1.1 I Manual Actuators are Unobstructed 7.2.2(2) P
(i.e. remote pull station)
1.2 ( I Tamper Indicators&Seals Intact I 7.2.2(3) I I IP
1.3 I I (Maintenance Tag in Place I 7.Title19(§906 I I IP
1.4 I I INo Obvious Physical Damage I 7.2.2(5) I I IP
1 5 I !Gauge Gauge Readings within Proper Limits 7 2 2(6)(Stored pressure) I I IN/A
1.6 ( I (Blow-
off Caps in Place&Undamaged I 7.2.2(7) I I IP
1.7 I I (Hoods,Ducts,Filters in Place and Clean I CFC 904.11.6.3 I I IP
I (Not Been ReolacedeMod ed or Cooking
Relocated
Have I 7 2 2($) I I IP
1.8 (
2.1 I T (Automatic Detection/Manual Actuation Functioned I 7.3.3.4 I I IP
orrectIv
Form AES 20 Sept.3.2013