HomeMy WebLinkAbout4600 MING AVENUEInspection, Testing, and Maintenance A€S20'Page 1 of _
Wet Chemical Pre - Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Nozzle
Type
Property Information:
Appliance Name
Name:I'lvl
Nozzle
Type
Address: JORGENSEN COMPANY
2691 South East Ave. City: tn1 i' i System
ZIP: C 5 Fresno, CA 93706 of
C16 Lic. # 262995
Contact:
3
Service Location:
Date: C- Telephone: 2691 S. East Ave Fresno 800 - 481 -3473
4
Copy sent to: 1536 Princeton Modesto 800 - 606 -0835
Owner Date A 2345 S. Fruitvale Bakersfield 877 - 238 -6305
PASS
Fire AHJ. Date 3190 Luyung Dr Rancho Cordova 800 - 758 -1124 FAIL
6
Service Technician 4 4 ""%' Owner /Occupant
7
Print Name I CJ'E"c in (' "r % Print Name /1 C1 t'c'._ ( c c C 2
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 may be performed by the property in accordance with CCR Title 19, Division 1, Chapter 5 §904.7
oowner
System Location System Mfg / `P-..` to Model #.i
Hoods Dimension(s)
Plenums Dimensions(s) XStanclard V -Bank
Ducts Dimensions(s) / !" x el .
Fuel /Heat Shut Off: Gas # Electrical # Integral Make Up Air Shut Down Yes No
Cylinder Size(s) & Qty r ) Last Hydrostatic Test Date(s) . J l0 Flow Points: Capacity r Used
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT WITH SIZES AND COVERAGE NOZZLES
Appliance Name Total
Flow Pts
Nozzle
Type
Nozzle
Qty
Appliance Name Total
Flow Pts
Nozzle
Type
Nozzle
Qty
3 4
5 6
7 8
FIXED TEMPERATURE - SENSING ELEMENTS (SUCH AS FUSIBLE LINKS)
QTY TEMP MFG DATE INSTALL DATE QTY TEMP MFG DATE INSTALL DATE
She -Fie Marshal AES2-9 Test Form 1012010
a
Inspection, Testing, and Maintenance -: A€S20 Page 2 of-
Wet Chemical Pre -Enineered Fire Extin6uishing Systems - Title 19 Chapter 5 § 904.7
Property Address: i t
System Location
Contractor Name: JORGENSEN COMPANY
Date:`
System of
Item Frequency . Description NFPA 17A
unless noted)
Fail N/A Pass
1 -1.1 Monthly Manual Actuators are Unobstructed
i.e.. remote pull station 7 2 2(2)
1 -1.2 Monthly Tamper Indicators and Seals Intact 7.2.2( -3)
1;1.3 Monthly Maintenance Tag in Place CCR T -19 906
1 -1.4 Monthly No Obvious Physical Damage 7.2.2(5)
1 -1.5 Monthly Gauge Readings within Proper Limits (Stored Pressure) 7.2.2(6)
1 -1.6 Monthly Blow -Off Caps in Place & Undamaged 7.2.2(7) x
11-1.7 Monthly Hoods, Ducts, Filters in Place and Clean CFC 904.11.6.3
1 -1.8 Monthly Hood, Ducts & Protected Cooking Appliances Have Not Been
Replaced Modified or Relocated 7 2 2(8)
T -1 Semi Annually Automatic Detection /Manual Activation Functioned Correctly 7.3.2.3 1y
T -1.2 Semi Annually Alarm Signals Functioned Correctly 7.3.2.3
T -1.3 Semi Annually Fuel Shut Off Operated Correctly . 7.3.2.3 X
T -1.4 Annually Regulator Tested and is Within Acceptable Limits 7.3.2.3
T -1.5 Semi Annually Manual Reset Relay Functioned Correctly (if applicable) 7.3.2.3
M -1.1 Semi Annually Complete All Inspection Items (1 -1.1 through 1 -1.8)
M -1.2 Semi Annually All Agent Containers within Acceptable Hydrostatic Test
Dates 7,5.1 1
M -1.3 Semi Annually All Auxiliary Pressure Containers and /or Hose Assemblies
Within Acceptable Hydrostatic Test Dates 7.5.1(2)(3)
M -1,4 Semi Annually Cartridge Weights within Acceptable Limits 7.3.2.1(2)
M -1,5 Semi Annually Liquid Level Within Acceptable Limits (Non- Pressurized) 7.3.2.1(2) X
M -1,6 Semi Annually No Signs of Corrosion inAgent Cylinder (Non- Pressurized) 7.3.2.1(2) V
M -1.7 Semi Annually Distribution Piping Unobstructed and Contiguous 7.3.2.1(3)
M -1,8 Semi Annually Nozzles are Correct, Clean & Properly Aimed 7.3.2.1(2) X
M -1.9 Semi Annually Fixed Temperature Sensing Elements Maintained or
Replaced CFC 514.2.2 L
M -2.0 Semi Annuallyy Auxiliary Equipment Such as Water Valves Functioned
Correct) 7.3.2.1 ( 2 )
M -2.1 6 Year Internal Maintenance as Required by the Manufacturer CCR T -19 904.7 1
I = Inspection M = Maintenance T = Test For additional deficiencies and comments use AES 9
Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above:
System Inspecteq, tested'and.maintained in accordance.with-manufacturer's written instructions and applicabToo
andards.(. §904.7)
PASS .
1:1 FAIL ;.'Jechnicia ' nature Date & Time of Service C s o er Acknowledgement
State FrFe MaFshali ES 20 rest Form 1012010
Inspection, Testing, and Maintenance A€S20 Page 1 of _
Wet Chemical Pre - Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Nozzle
Qty
Property Information: sZ
Nozzle
Type
Name:
ZS
Ji
Address: LI Ave, JORGENSEN COMPANY
2
City: i ` i > 1 2691 South East Ave. System
ZIP:
Fresno, CA 93706 X. of
1
C16 Lie. # 262995
Contact:
5
Service Location:
Date: Telephone: El 2691 S. East Ave Fresno 800 - 481 -3473
1536 Princeton Modesto 800 - 606 -0835Copysentto:
Owner Date In 2345 S. Fruitvale Bakersfield 877 - 238 -6305
PASS
Fire AHJ Date 3190 Luyung Dr Rancho Cordova 800 - 758 -1124 FAIL
Service Technician ' >.r %- '$ Owner /Occupant
Print Name TS cc' i c -t 1 Print Name
j 1 c YlZs ate 7
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 s ir+(° r F System Mfg -A'P" 1 Model # -
U /
Hoods Dimension(s) i
4
Plenums Dimensions(s) l Standard V -Bank
f
Ducts Dimensions(s)
Fuel /Heat Shut Off: Gas # } Electrical # Integral Make Up Air Shut Down Yes No
Cylinder Size(s) & Qty. Last Hydrostatic Test Date(s) _L_J,kti Flow Points: Capacity Used
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT WITH SIZES AND COVERAGE NOZZLES
Appliance Name Total
Flow Pts
Nozzle
Type
Nozzle
Qty
Appliance Name Total
Flow Pts
Nozzle
Type
Nozzle
qty
Ji
1
2
3 f '" Yc'r i 1
4
5 6
7 8
FIXED TEMPERATURE - SENSING ELEMENTS (SUCH AS FUSIBLE LINKS)
QTY TEMP MFG DATE INSTALL DATE QTY TEMP MFG DATE INSTALL DATE
Ji
1
State Giro MaF6hal AES 20 Test Form 1012010 -
Inspection, Testing, and Maintenance A E92-0 Page 2 of
Wet:Chemical Prett- En ineered Fire Extinguishing Systems - Title 19 Chapter 5 904.7
Property Address: I L)o 4(`
t ,
System Location
Contractor Name: JORGENSEN COMPANY
Date:
System -- of
Item Frequency Description NFPA 17A
unless noted)
Fail N/A Pass
1.1 Monthly
Manual Actuators are Unobstructed
i.e. remote pull station)
7.2.2(2)
1 -1.2. Monthly Tamper Indicators and Seals Intact 7.2.2(3)
1 -1.3 Monthly Maintenance Tag in Place CCR T -19 906
1 -1.4 Monthly No Obvious Physical Damage 7.2.2(5)
1 -1.5 Monthly Gauge Readings within Proper Limits (Stored Pressure) 7.2.2(6)
1 -1.6 Monthly Blow -Off Caps in Place & Undamaged 7.2.2(7) X
1 -1.7 Monthly Hoods, Ducts, Filters in Place and Clean CFC 904.11.6.3 Y,
1 -1.8 Monthly Hood, Ducts & Protected Cooking Appliances Have Not Been
Replaced Modified or Relocated 7 2 2(8) X_
T -1 Semi Annually Automatic Detection /Manual Activation Functioned Correctly 7.3.2.3
T -1.2 Semi Annually Alarm Signals Functioned Correctly 7.3.2.3
T -1.3 Semi Annually Fuel Shut Off Operated Correctly 7.3.2.3
T -1.4 Annually Regulator Tested and is Within Acceptable Limits 7.3.2.3 y
T -1.5 Semi Annually Manual Reset Relay Functioned Correctly (if applicable) 7.3.2.3
M -1.1 Semi Annually Complete All Inspection Items (1 -1.1 through 1 -1.8)
M -1.2 Semi Annually All Agent Containers within Acceptable Hydrostatic Test
Dates 7.5.1 1
M -1.3 Semi Annually All Auxiliary Pressure Containers and /or Hose Assemblies
Within Acceptable Hydrostatic Test Dates 7.5.1(2)(3)
M -1.4 Semi Annually Cartridge Weights within Acceptable Limits 7.3.2.1(2)
M -1.5 Semi Annually Liquid Level Within Acceptable Limits (Non- Pressurized) 7.3.2.1(2)
M -1.6 Semi Annually No Signs of Corrosion in Agent Cylinder (Non- Pressurized) 7.3.2.1(2)
M -1.7 Semi Annually Distribution Piping Unobstructed and Contiguous 7.3.2.1(3)
M -1.8 Semi Annually Nozzles are Correct, Clean & Properly Aimed 7.3.2.1(2)
M -1.9 Semi Annually Fixed Temperature Sensing Elements Maintained or
Replaced CFC 514.2.2 5(
M -2.0 Semi Annuallyy uxiliary Equipment Such as Water Valves Functioned
Correctly 7,3.2.1 2
M -2.1 6 Year Internal Maintenance as Required by the Manufacturer CCR T -19 904.7
I = Insnection M = Maintenance T = Test For additional deficiencies and comments use AES 9
Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above:
System Inspected, tested, and maintained in accordance with manufacturer's written instructions and applicable standards,j11 §904.7)
t PASS ,!..
yam
1/
FAIL ;,F Technician Signature Date & Time of Service Custo , er Acknowledgement
Wass -e"- IT,, 7.11.— ForM 11v2#141es.
Inspection, Testing, and Maintenance AES20 Page 1 of
Wet Chemical Pre - Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Property Information:
Nozzle
Qty
Appliance Name
Name: /V iF J )NCA ( c
Nozzle
Type
Nozzle
qty
Address. 1.a3 `-1AN JORGENSEN COMPANY
City: .i l°YSrr a:; 01 2691 South East Ave. System
ZIP:
Fresno, CA 93706 of
C16 Lic. # 262995
Contact:
Telephone:
Service Location: Date:
2691 S. East Ave Fresno 800 - 481 -3473
1536 Princeton Modesto 800- 606 -0835Copysentto:
Owner Date rC1 2345 S. Fruitvale Bakersfield 877 - 238 -6305 PASS
Fire AHJ Date 3190 Luyung Dr Rancho Cordova 800 - 758 -1124 FAIL
Service Technician , if P u _ , ; " Owner /Occupant
Print Name E '`dY j')rn r `% 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 may be performed by the property owner in accordance with CCR Title-19, Division 1, Chapter 5 §904.7
System Location cl System Mfg /rSLA i Model # i JI-
1
Hoods I Dimension(s)
1
Plenums Dimensions(s) Standard V -Bank
iDucts Dime` nsions(s)
Fuel /Heat Shut Off: Gas # Electrical # Integral Make Up Air Shut Down Yes No
Cylinder Size(s) & Qty " i Last Hydrostatic Test Date(s) ) i tl) Flow Points: Capacity /! Used
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT WITH SIZES AND COVERAGE NOZZLES
Appliance Name Total
Flow Pts
Nozzle
Type
Nozzle
Qty
Appliance Name Total
Flow Pts
Nozzle
Type
Nozzle
qty
1
1
2
r yr-
3 4
5 6
7 8
FIXED TEMPERATURE- SENSING ELEMENTS (SUCH AS FUSIBLE LINKS)
QTY TEMP MFG DATE INSTALL DATE QTY TEMP MFG DATE INSTALL DATE
1
State Fir Marshal A ES 20- Test Form 1012010
Inspection, Testing, and Maintenance - 8 Page 2 of
Wet Chemical Pre -En ineered-Fire Extin uishin Systems - Title 19 Chapter 5 § 904.7
Property Address:
Date:
System Location : ' J-a—A System of
Contractor Name: JORGENSEN COMPANY
Item Frequency Description NFPA 17A' -. Fail N/A Pass
unless noted)
1.1 Monthly Manual Actuators are Unobstructed 7'2'2(2) i.e. remote pull station)
1 -1.2 Monthly Tamper Indicators and Seals Intact 7.2.2(3) r
1 -1.3 Monthly Maintenance Tag in Place CCR T -19 906
1 -1.4 Monthly No Obvious Physical Damage 7.2.2(5)
1 -1.5 Monthly Gauge Readings within Proper Limits (Stored Pressure) 7.2.2(6)
1 -1.6 Monthly Blow -Off Caps in Place & Undamaged 7.2.2(7)
1 -1.7 Monthly Hoods, Ducts, Filters in Place and Clean CFC 904.11.6.3
1 -1.8 Monthly Hood, Ducts & Protected Cooking Appliances Have Not Been 7 2 2(8) Replaced Modified or Relocated
T -1 SerAi Annually Automatic Detection /Manual Activation Functioned Correctly 7.3.2.3
T -1.2 Semi Annually Alarm Signals Functioned Correctly 7.3.2.3
T -1.3 Semi Annually Fuel Shut Off Operated Correctly 7.3.2.3
T -1.4 Annually Regulator Tested and is Within Acceptable Limits 7.3.2.3
T -1.5 Semi Annually Manual Reset Relay Functioned Correctly (if applicable) 7.3.2.3
M -1.1 Semi Annually Complete All Inspection Items (1 -1.1 through 1 -1.8)
M -1.2 Semi Annually All Agent Containers within Acceptable Hydrostatic Test 7.5.1(1) Dates IC
M -1.3 Semi Annually All Auxiliary Pressure Containers and /or Hose Assemblies 7.5.1(2)(3) t
Within Acce table Hydrostatic Test Dates
M -1.4 Semi Annually Cartridge Weights within Acceptable Limits 7.3.2.1(2)
M -1.5 Semi Annually Liquid Level Within Acceptable Limits (Non- Pressurized) 7.3.2.1(2)
M -1.6 Semi Annually No Signs of Corrosion in Agent Cylinder (Non- Pressurized) 7.3.2.1(2)
M -1.7 Semi Annually Distribution Piping Unobstructed and Contiguous 7.3.2.1(3)
M -1.8 Semi Annually Nozzles are Correct, Clean & Properly Aimed 7.3.2.1(2)
M -1.9 Semi Annually Fixed Temperature Sensing Elements Maintained or CFC 514.2.2Replaced f
M -2.0 Semi Annually Auxiliary Equipment Such as Water Valves Functioned 7.3.2.1(2) Correct)
M -2.1 6 Year Internal Maintenance as Required by the Manufacturer CCR T -19 904.7
I = Inspection M = Maintenance T = Test For additional deficiencies and comments use AES 9
Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above:
System Inspected,.tested.and maintained.in- accordance with manufacturer's written instructions and applicable standard -(T -19 §904.7)
PASS
FAIL Technician Signature Date & Time of Service. C tosujeerAcknowledgement ;
State Ciro MaFshal E—S 20 Test Form 1012010