HomeMy WebLinkAboutFAI15-0001 060-060-012 CF Ansul 2023 A 1 I s--0u0! 666 -06a-0>2
Wet Chemical Pre-Engineered California Code of Regulations-Title'19 Semi-Annual , '
Fire E Inguishing Systeminspection,Testing,and Maintenance Report
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Property Information ,.ti F /k9l)I Contractor or Licensed Owner Information
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'Building Name f rr4,1,,,1 Lig yc . t. �" A �" 'Name Wilgus Fire Control Inc.
'Address 2 / '3 czi 5-
Iti ""r ' , „,i .-.S. !'..,, tP Address 4544 Mountain Lakes Blvd.
CL'�ic
„ / 1 -MPP� 'City Redding St. CA Zip 96003
'City ,45 17-t. 117e4vG,6& <, 'License# 462979 1Phone 530-241-2465
'Contact Person 1 ❑ SFM (Job# _
'Phone 9/6 ?4 i3 32`7 9/ I Pj CSLB 'Misc.
' a System information ,14-... . x .,':•'
Cylinder Size eft Last Hydrostatic Test Date f Q /1 1 Flow Points Capacity J,)sed '„',2'
(System Location /1(,'f"-e,,L-t-- System Mfr. A-Af s att Model# 1c le"-
IFuellHeat Shut Off: .„ {
Gas# X Electrical# Integral Make Up Air Shut Down __
r ,� e. Total
� `� ��ft` m � �� �e `z tit � i�¢�i � o�t
s f a �I r. .. ' oci �. bw`!o n c�. Oty Flow Points
!Hoods I !, Milt 2. S 5' Y I I I
(Plenums I 2 I ' - I / Ai I I I I 4
'Ducts I 12. I i 1417 /�Z Xt21 2 tt 1 I -- I "" I 4;
1 7,47 Cooking Appliances
Left to Right with Sizes and Coverage Nozzles
t r^t N0221e Nailiki Total: 51 ',N;P p leLile Nozzle Total
I� PRitan Name Model- F'FlavuPaintsIFiowPoinis ' pP!i�it0e--Nar a i1) � `„,� bail I Flow Pnts Flow Points
I l . Lrc//..Y.7 I 3A/ I I `V II I
,+w„ �� 1
h -F-1 i I I
ri;611,, I iA.r I i I ,
I I
I ' I I ' II I I I I
Fixed Temperature Sensing Elements
(Such as Fusible Links)
�� . A, Mfr ' a 4 4i �.-4 , • Mfr Install
i i-' d 144i , .. 401- ° ate a ,,a a y' T cn i Rate 1
'` °. � Date
I ! I `34r Z.. 2...'3 II I I I
I I I I I I I I I I
inspection,Testing, and Maintenance _
1 =Inspection T =Test NI=Maintenance P=Pass F=Fail N/A=Not Applicable
item I Deacri tten ' A111 1i tDateA fr Gommenis OnlyP,F,N/A
w,:.. .., �
1 1 I ii
'Manual Actuators are Unobstructed 7 2 2 2
( e
(i.e.Remote Pull Stations
( )
1.2 I Tamper Indicators&Sea
ls Intact 1 7.2.2(3) I I I f
1.3 I 'Maintenance Tag in Place I 7.2.2(4) I m
Title 19$906
1.4 ( I INo Obvious Physical Damage I 7.2.2(5)
1.5 t Gauge Readings within Proper Limits 7.2.2(6} /},7/°
'Gauge
Pressure) I ! _/__ _
1.6 I (Blow-Off Caps in Place&Undamaged I 7.2.2(7) I f
1.7 I 'Hoods,Ducts,Filters in Place and Clean I CFO 904.11.6.3 I P
Cooking Ducts&Protected Appliancesl ) .. __•.
'Hood,
Been Replaced,Modified or RelocatelHave ( I I
1.8 i7.2.2&
2.1 T 'Automatic Detection/Manual Actuation Functioned 7,3.3.4 1 I
cliioCarrectiv . .... I
Form AES 20 Sept. 3,2013
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i' ‘, firdiTErgii4tfigirieired California Code of Regulations-Title 19 Semi-Annual 2 of 2
Fire xtlttgUlshing System Inspection,Testing,and Maintenance Report
•Property Information /,� `L��p Contractor or Licensed Owner Information
r "r`�to r`�N.
f3uilding Name ec... t . lit c{c�..a-,� C."`'-L—s 1% Job#
,'�7, l p Name Wilgus Fire Control Inc.
q
Address (� � �' 9rGr e.�/s+,Ti7 �`t ':
City tj5L4 r !w ,(2i'.clot�241`I 411 rEErstfti
�..
��‘ � "a �• -
. 2te,� Inspection, Testing,and Maintenance
I =Inspection T =Test M=Maintenance P=Pass F Fail N/A=Not Applicable
i4,, :,x is yx ar vV car,, • r `('r '` §° kYr„'.
ItQtn 11S fit' 1. . Ote kSiM t .... s V I f, i I';1
FuelOperated. Correctly I 7.3.3.4
2.2
T Shut-Off
•
2.3 T Regulator Tested 8 is within Acceptable Limits I 7.3.3.4 I 11 .
Manual Reset Relay Functioned Correctly
2.4 T ;If Applicable) 7.3.3.4 I ,{/
3.1 M IAll Agent Containers within Acceptable Hydrostatic I 7,5.1(1)
Test Dates
All Auxiliary Pressure Containers and/or Hose
3.2 tot Assemblies within Acceptable Hydrostatic Test Dates I 7•5•1(2)(3) I$
3.3 M ICartriidge Weights within Acceptable Limits 1 7.3,3.1(2) I I yf-1 1
3.A M Liquid Level within Acceptable Limits I 7.3.3.1(2) I I
(Non-pressurized) J
3 5 tit No Signs of Corrosion in Agent Cylinder I 7.3 3 1(2) I
(Non-pressurized) 641
3.6 lot Distribution Piping Unobstructed and Contiguous I 7.3.3.1(3) I fi
3.7 M Nozzles are Correct,Clean 8 Properly Aimed I 7.3.3.1(2) I f
3.8 ,,1 Fixed Temp Fusible Metal Alloy Type Detectors Replaced! 7.3.4 !
_ Fixed-Temp(Other Than Fusible Metal Alloy Type)8, 7.35
3,9 M Heat Detectors Maintained or Replaced I Ip/I4,
3 10 M (Auxiliary Equipment Such as Water valves I 7.3.3.1(2) I I ill 4�1,.I
Functioned Correctly
I 3.11 M (Internal Maintenance as Required by Manufacturer I Title 19§904.7 I I tit
I=Deficiency C=Comment (indicate pipe)
tt,tern Date miser P ( trlc+ atg all a r,enf es ant "r7rt rrient
s,r< _ to tc ea
qup. s rdp.rrfr r+,r k.. c, ',' ,
F
I I I
l Check here if arldrtionat Deficiencies and Comments are listed on Form AES 9, Number attached:
I . r( � 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/9,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 fi -e-I CL w h t—e--% ' "!
ISignature C;%Illl t Date 5—/2---2,`) I
V Fern,AFS 20 Sept.3.2013