HomeMy WebLinkAboutFIRE EXTIN. TEST 9/28/2011Inspection, festini, and Maintenance
Total Nozzle
AES20 Page 1 of
Wet Chemical Pre - Engineered Fire Extinguishing Systems - Title 19'Chapter 5 § 904.7
Property Information:
Nozzle
Name: T != t Q 1c' I::-
Flow Pts Type
Address: l';I w. _t_t , > JORGENSEN COMPANY
Flow Pts
City: i' -r . u( <' 1= _I U 2691 South East Ave. System
ZIP. I ' Fresno, CA 93706 of
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C16 Lie. # 262995
Contact: F if. N,C; ir. )c'F7
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Telephone:
Service Location:
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2691 S. East Ave Fresno 800 -481 -3473
IS36 Princeton Modesto 800- 606-083S
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Copy sent to: L)"51,41OwnerDatei,cl R, 2345 S. Fruitvale Bakersfield 877 - 238 -0305 FPASS
Fire AHJ Date 3190 Luyung Dr Rancho Cordova 800 -758 -1124 FAIL
Service Technician f Owner /Occupant
Print Name KEN F Print Name l /,aU(,t'
NOTES 1) for specific Inspection, testing, and maintenance requirements and information, see California Code of Regulations, Title 19,
Division 1, Chapter 5, 5901 to 9906
2) Inspection Items may be performed by the property owner in accordance with CCR Title 19, Division 1, Chapter 5 5904.7
System Location `' TPT" ("F= System Mfg ,x,94r,t (A)h odel # 7%S
Hoods Dimension(s) , rr• .+7c -C a - «NTL
Plenums Dimensions(s) 9- Stander4--94 -Bank
Ducts - Dimensions(s)
Fuel /Heat Shut Off: Gas # 1 Electrical # Integral Make Up Air Shut Down yes No
Cylinder Size(s) & Qty S X I _Last Hydrostatic Test Date(s) D-ai- FQfe.. M 'Flow Points: Capacity Used 7
COnKING APPI IANCF LOCATIONS! IFFT TA RIGHT WITH S17FS AND COVERAGE N077LF5
Appliance Name Total Nozzle Nozzle Appliance Name Total Nozzle Nozzle
Flow Pts Type Qty Flow Pts Type Qty
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ALL N l < J Yr ,
5 6
7 8
FIXED TEMPERATURE - SENSING ELEMENTS (SUCH AS FUSIBLE LINKS)
QTY TEMP MFG DATE INSTALL DATE QTY TEMP MFG DATE INSTALL DATE
ri /-DO i t
Test Form 1012090
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13
Inspection,`Testi-rg, 4nd Maintenance' ° ' ` ' `AES20. Page".2 of
Wet Chemic9l Prelin ineered Eire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Property Address: 1Zt /. 17-12,
System Location: T , — k (} Ci
Contractor Name: CG -
Date: Ce-'( % QS 1 )
System I of
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Item Frequency Description NFPA
noted) {unless nooted}
Fail N/A Pass
1.1 Monthly Manual Actuators are Unobstructed
i.e. remote ull station 7'2.2(2)
1 -1.2 Monthly Tamper Indicators and Seals Intact 7.2.2(3) X
1 -1.3 Monthly Maintenance Tag in Place CCR T -19 906 Xx
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 X
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
T4.4 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 ithin 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 Annuallyy ixed Temperature Sensing Elements Maintained or
Replaced CMC 514.2.2
M -2.0. Semi Annually 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
I _ Insnection All = 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 maintained In accordance with manuf_acturers wrilten instructions and applicable elan rids 19 §2
IR / PASS _ -- Oq /Z!l
Q FAIL Te Ian Signature Date & Time of Service Customer Acknowledgement
State Fire Marshal AES 20 10/26/10