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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 7 1 4. ' Name: U w.. 2 Address: C - ' v JORGENSEN COMPANY City: f , P t -r 2691 South East Ave. Systemy ZIP: - Fresno, CA 93706 of C16 Lic. # 262995 5 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 8 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 4. ' w.. 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 f 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) F'HSS FAIL Technici' n Signature Date & Time of Service Customer Acknowledgement 6 ssr_ ftm, e asti ,,.ili._tea a:sra l.zr. I" i d O