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Inspection, ,resting, and Maintenance t 1 AE B Page 1 of
Wet Chemical Pre - Engineered Fire Extinguishing Syste s - Tifle 19 Chapter 5 § 904.7
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Property Information:
Appliance Name Total
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IName:C t1
Nozzle
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Type Qty
Address: _`C. JORGENSEN COMPANY
Type
City: l) / r ti %// 2691 South East Ave. System
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ZIP: 733 6) Fresno, CA 93706 of
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Contact:
C1.6 Lic. # 262995
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Telephone: % /
Service Location:
Date:
2691 S. East Ave Fresno 800 - 481 -3473
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Date 67 5J
15 6 Modesto 800 - 606 -0835 E I'PASSLUwnerC345S. Frultvale Bakersfield 877 - 238 -6305
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Fire AHJ Date 3190 Luyung Dr Rancho Cordova 800 - 758 -1124
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Service Technician f• - _ _ Owner /Occupant
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Print Name Print Name
NOTES 1) For specific inspection, testing, and maintenance requirements and information, see California Code of Regulations, Title 19,
Division 1, Chapter 5, §901 to §906
2) Inspection items maybe performed by the property owner in accordance with CCR Title 19, Division 1, Chapter 5 §904.7
System Location .VF System Mfg / Model # . ;000
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Hoods i Dimension(s)
Plenums Dimensions(s) C% E?Sadard V -Bank
Ducts Dimensions(s)
Fuel /Heat Shut Off: Gas # Electrical # Integral Make Up Air Shut Down Q Ye' s No
Cylinder Size(s) & Qty _.3 Ci Last Hydrostatic Test Date(s) 20o Flow Points: Capacity OV Used O0
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT WITH SIZES AND COVERAGE NOZZLES
Appliance Name Total Nozzle Nozzle Appliance Name Total Nozzle Nozzle
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Flow Pts Type Qty Flow Pts Type Qty
1 2
2,1 OlAe
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6
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7
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FIXED TEMPERATURE - SENSING ELEMENTS (SUCH AS FUSIBLE LINKS)
QTY TEMP MFG DATE INSTALL DATE QTY TEMP MFG DATE INSTALL DATE
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State Fire Marshal A Ge 20- Test Form 1012010