HomeMy WebLinkAbout6300 WHITE LANE (4)Inspectiob, lksting, and Maintenance Page 1 of _
Wet Chemical Pre- Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Nozzle
Qty
Property Info ation: /
Total
Flow Pts
Nozzle
Type
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Address: C - ' v JORGENSEN COMPANY
City: f , P t -r 2691 South East Ave. Systemy
ZIP: -
Fresno, CA 93706 of
C16 Lic. # 262995
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Contact:
6
Telephone: L & - 3 - L- j00
Service Location:
7
2691 S. East Ave Fresno 800 - 481 -3473
1536 Princeton Modesto 800 - 606 -0835
Z Bakersfield 877 238 7PASS701WInerentto:
Date l
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S. Fruitvale - -6305
FAIL
Fire AHJ Date 3190 Luyung Dr Rancho Cordova 800 - 758 -1124
Service Technician P' f Owner /Occupant \J' Z2 C, c, t
Print Name Print Name % C1/Z l f-4 U /_ 0
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
rl . P. Sys em Mfg > Model # i1 , System Location _ , ;"
Hoods Dimension(s) ( 40
Plenums Dimensions(s)
v! ! .o )- Standard V -Bank
Ducts Dimensions(s) Bz 1 iP 5
kMFuel /Heat Shut Off: Gas # Electrical # Integral Make Up Air Shut Down L Yes-Q"No
Cylinder Size(s) & Qty. / 4 )Last Hydrostatic Test Date(s) U Flow Points: Capacity Used UL
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
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2
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
2
Test Form 1012010
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Inspection, -7
esting, and Maintenance - ` AES2A Page 2 of _
Wet ChemicSPre -En ineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Property Address: yyr Ct
System Location : awl t /'
Contractor Name: JORGENSEN COMPANY
Date: &" 2,7' I ,
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)
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
Replaced Modified or Relocated 7 2 2(8)
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
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 Annuall y 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
r
M -2.0 Semi Annually Auxiliary 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 = Insaection 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 pplicable star d (T -19 §qz7)
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FAIL Technici' n Signature Date & Time of Service Customer Acknowledgement
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