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Home My WebLink About10750 STOCKDALE Hwy (2)Inspection, Testing, and Maintenance A€ 20 Page 1 of Wet Chemical Pre - Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7 Property Information: Nozzle Appliance Name Name: Nozzle Nozzle Address: / U ZaP S JORGENSEN COMPANY Type City: 2691 South East Ave. System Type Fresno, CA 93706 2 of ZIP: C16 Lic. # 262995 f Contact: 2 IY 72 y l Telephone: Service Location: c Date: ��• / l � ❑ 2691 S. East Ave Fresno 800 - 481 -3473 El 1536 Princeton Modesto 800 - 606 -0835 1 1 CCo�oppy�y sent to: E� wner Date /,Z - % �� ❑ 2345 S. Fruitvale Bakersfield 877 - 238 -6305 I_�PAS S ❑ Fire AHJ Date ❑ 3190 Luyung Dr Rancho Cordova 800 - 758 -1124 FAIL Service Technician Owner /OccupanN Print Name Print Name ` V _O"5�_ fflnjf 161 khl 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 System Location c4 cic System Mfg /(,.;�?r'i r Model # 7 757 # Hoods Dimension(s) hl/ # Plenums Dimensions(s) 1 ! % / / / ❑- Srtanndard ❑ V -Bank # Ducts Dimensions(s) /GX /'e' Fuel /Heat Shut Off: Gas #__jf�f�Electrical # A—"- Integral Make Up Air Shut Down ❑ Yes ❑ No Cylinder Size(s) & Qty Last Hydrostatic Test Date(s) C/ Z Flow Points: Capacity .Used COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT WITH SIZES AND COVERAGE NOZZLES Appliance Name Total Nozzle Nozzle Appliance Name Total Nozzle Nozzle Flow Pts Type Qty Flow Pts Type qty 13727 f 2 6:,,W1 -r- 2 IY 72 y l 3 / 1�7Zc 4 /?� /c /Z� 5 W2 ! 1 6 C� sr:C till _r 1l Glv v FIXED TEMPERATURE - SENSING ELEMENTS (SUCH AS FUSIBLE LINKS) QTY TEMP MFG DATE INSTALL DATE QTY TEMP MFG DATE INSTALL DATE State Fire Marshal AES 20 Test Form 1012010 U Inspection, Testing, and Maintenance A€S2 Page 2 of Wet Chemical Pre-Engineered Fire Extinguishing Systems '- Title 19 Chapter 5 § 904.7 Property Address: I�J / System Location : (/ 7�� 51r,C`` da /6 �G`-✓% Contractor Name: JORGENSEN COMPANY / Date: /Z- IV //0 System ,2 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) 1 -1.2 Monthly Tamper Indicators and Seals Intact 7.2.2(3) c/ 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) s 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 i 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 i- M-1.1 Semi Annually Complete All Inspection Items (1 -1.1 through 1 -1.8) �-°- KA*.2 Semi Annually y ll Agent Containers within Acceptable Hydrostatic Test Dates 7.5.1 1 ( ) 0 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) e/ 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 y ixed Temperature Sensing Elements Maintained or Replaced CFC 514.2.2 M -2.0 Semi Annually y uxiliary 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 = Inspection 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: i System Inspected, tested and maintained in accordance with manufacturer's written instructions and applicable-standard (T -19 §904.7) ❑ FAIL TechnieiafliSignature Date & Time of Service Customer Acknowledgement State Ciro Marshall nES 20 Test Form 1012010 Inspection, Testing, and Maintenance �A€S20 Page 1 of Wet Chemical Pre - Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7 Property Information: Nozzle Qty Appliance Name Name: J 15 Nozzle Type — Address: / %SCE S4�c %ce /`' JORGENSEN COMPANY City: /31- /4 2691 South East Ave. System Fresno, CA 93706 /of- ZIP: C16 Lie. # 262995 Contact: 5 Service Location: Date: Telephone: ❑ 2691 S. East Ave Fresno 800 - 481 -3473 ❑ 1536 Princeton Modesto 800 - 606 -0835 pp PASS Copy sent-to: 1 ( 9wner Date i " %d El 2345 S. Fruitvale Bakersfield 877 - 238 -6305 ❑ Fire AHJ Date ❑ 3190 Luyung Dr Rancho Cordova 800 - 758 -1124 FAIL � Service Technician Owner /Occupan�v Print Name Aid• %'� Print Name% 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 may be performed by the property owner in accordance with CCR Title 19, Division 1, Chapter 5 §904.7 System Location c oT Aloe c/ System Mfg Aen P / r yr Model # 7/ -7 Srdl # Hoods Dimension(s) 12 /` # Plenums ( Dimensions(s) 1267— QOS fandard ❑ V -Bank Ducts Dimensions(s) �,! A- li - Fuel /Heat Shut Off: Gas # Electrical # 4% Integral Make Up Air Shut Down [3 es ❑ No /(/-e -a I Cylinder Size(s) & Qty / /027 Last Hydrostatic Test Date(s) / J Q Z Flow Points: Capacity Used COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT WITH SIZES AND COVERAGE N077LFS Appliance Name Total Flow Pts Nozzle Type Nozzle Qty Appliance Name Total Flow Pts Nozzle Type Nozzle Qty 2 3 4 5 6 7 S FIXED TEMPERATURE - SENSING ELEMENTS (SUCH AS FUSIBLE LINKS) QTY TEMP MFG DATE INSTALL DATE QTY TEMP MFG DATE INSTALL DATE State Fmo.o nn -ARShal AES 20 Test Form 1012010 ?TK. ty tl L Inspection, Testing, and Maintenance r-li K_ f / ' / / [ r' / 12� � -AESA Page 2 of _ Wet Chemical Pre-Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7 Property Address: S / P / -TV S1zzleAlc Date: �2 ` X/,) — � l / //// System Location:— �1�� 1 I G7/ hYJG-/ System _�of / Contractor Name: JORGENSEN COMPANY Item Frequency Description NFPA 17A (unless noted) Fail N/A Pass -1.1 Monthly Manual Actuators are Unobstructed 7.2.2(2) i.e. remote pull station 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 7 2 2(8) .� Replace Modified or Relocated 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 0' 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 a---- M -1.1 Semi Annually Complete All Inspection Items (1 -1.1 through 1 -1.8) m--- M-1.2 Semi Annually y ll Agent Containers within Acceptable Hydrostatic Test 7.5.1 1 ( ) s' Dates M -1.3 Semi Annually All Auxiliary Pressure Containers and /or Hose Assemblies 7.5.1(2)(3) �--- Within Acceptable Hydrostatic Test Dates 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) a--� M -1.9 Semi Annually y ixed Temperature Sensing Elements Maintained or CFC 514.2.2 �- Replaced M-2.0 Semi Annually y uxiliary Equipment Such as Water Valves Functioned 7.3.2.1(2) Correctl M -2.1 6 Year Internal Maintenance as Required by the Manufacturer CCR T -19 904.7 Z I = Insoection 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 applicable standards §904.7) 0 PASS �� /L.- ti ) ' / fG ,,-7 ❑ FAIL Technician Signature Date & Time of Service Customer Acknowle gement State Gw.o Marshaal AES 20 Test Form 1012010