HomeMy WebLinkAboutINSP TESTING 4/2/201Inspection, Testing,•and Maintenance
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Wet Chemical pre- Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Property Information:
Appliance Name Total
Flow Pts
i Pe r
Nozzle
Qty
Name: Ccr-
Address: to le S (.
lam
5 f/ JORGENSEN COMPANY
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City: /Tt, -5 6 / 2691 South East Ave.
ZIP: 30 Fresno, CA 93706
ESystem
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C16 Lie. # 262995
Contact: 76
Telephone: j/ - (, 01
Service Location:
Date : }.f -- //
El 2691 S. East Ave Fresno 800 - 481 -3473
1536 Princeton Modesto 800 - 606 -0835
Fruitvale Bakersfield 877 238
PACopysentto:
Owner Date
7
025. - -6305
FAILElFireAHJDateEl3190LuyungDrRanchoCordova800 - 758 -1124
Service Technician —d = Owner /Occupantsr
P "rint Name Print Name'
NOTES
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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 `) f & C_ o k hloc X System Mfg CCa i/ e, , Model # 4 A/
Hoods Dimension(s) f N
Plenums Dimensions(s) CI X __21 Standard FI-V_-Ban k
Ducts. Dimensions(s)
Fuel /Heat Shut Off: Gas # A"'- Electrical # Integral Make Up Air Shut Down .4;3-Yes-'0 No
Cylinder Size(s) & Qty , `7 l! Last Hydrostatic Test Date(s)' Flow Points: Capacit&Used J_
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
7 8
FIXED TEMPERATURE - SENSING ELEMENTS (SUCH AS FUSIBLE LINKS)
QTY TEMP MFG DATE INSTALL DATE QTY TEMP MFG DATE INSTALL DATE
State Fire Marsha! -°ES 20 Test Form 1012010
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Inspection . Maintenance V - 9 Page 2 of
Wet Chc l -re -En in/eered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7
Property Address: e! C
System Location: 0--.
Contractor Name: JORGENSEN COMPANY
Date: , -,°
System r 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)x'°
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
1.8 Monthly Hood, Ducts & Protected Cooking Appliances Have Not Been
Re laced Modified or Relocated 7'2'2(8) c-
x -1 Semi Annually Automatic Detection /Manual Activation Functioned Correctly 7.3.2.3 f
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) r --
M -1.2 emi Annually All Agent Containers within Acceptable Hydrostatic Test
Dates 7.5.1(1) x_
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
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
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 ap' applicable ndards" T- 9,§904.7
PASS ''j% <e- ...'. /'
FAIL Technician Signature Date & Time of Service Customer Acknowledgement
State Fmre MaFshal AES 20 Test Form 1012010
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