HomeMy WebLinkAbout6701 WHITE LANE (2)Inspection, Testing, and Maintenance A€S28 Page 2 of
Wet Chemival- Pre-Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Property Address: r, L Ad_
System Location : ',i1CK t: 1
Contractor Name: JORGENSEN COMPANY
Date: _;
37
System 2 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
Re laced Modified or Relocated 7 2 2(8) if
T -1 Semi Annually Automatic Detection /Manual Activation Functioned Correctly 7.3.2.3 r/
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 Ij
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 AnnuallySemiAnnuall All Agent Containers within Acceptable Hydrostatic Test
Dates 7,5.1 1O rf
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) V
M -1.6 Semi Annually No Signs of Corrosion in Agent 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)
M -1.9 Semi Annually Fixed Temperature Sensing Elements Maintained or
Replaced CFC 514.2.2
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 CC T -19 904.7 ff
I = Inspection WI = maintenance i = i est , ror auumonai uenciencies anu comments use mrw a
Item Deficiencies and Comments: Deficiencies and Comments Item number must correspond to the Item number of the Activity listed above:
System Inspected, tested and mai iained in accordance with manufacturer's written instructiKand ppli bl standards (T -19 §904.7)
El PASS -
FAIL Technician Signature
J
Date & Time of ServiceCustomer Acknowledgement
State Ciro Maas al AES 20 Test Form 1012010