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Home My WebLink About8110 ROSEDALE Hwy (3)' 3T "I, Inspection, Testing, and Maintenance- ``� = i -3� A€0 Page 1 of Wet Chemical Pre - Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7 Property Information: Nozzle Qty Appliance Name J f k Name: )0 f ' Nozzle Type Nozzle Qty Address: v�� < � - �� l�G c,�� JORGENSEN COMPANY I City: �'�!; d r� % rlfi U 2691 South East Ave. System ZIP: / Fresno, CA 93706 / of Contact S C16 Lic. # 262995 4 p �� D v Tele hone: Service Location: Date: / �� & 5 ❑ 2691 S. East Ave Fresno 800 - 481 -3473 Copy sent to: 3 'Owner l ❑ 1536 Princeton Modesto 800 - 606 -0835 �T1 PASS Date 1j- ! f X2345 S. Fruitvale Bakersfield 877 - 238 -6305 ❑ Fire AHJ Date ❑ 3190 Luyung Dr Rancho Cordova- 800 - 758 -1124 FAIL , Service Technician Owner /Occupant � Print Name 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 maybe performed by the property owner in accordance with CCR Title 19, Division 1, Chapter 5 §904.7 System Location System Mfg A,7_sJl Model # ` # Hoods Dimension(s) A dod le 5'5 � ndard # Plenums Dimensions(s) r,P (J ❑iSt ❑ V -Bank # Ducts Dimensions(s) Fuel /Heat Shut Off: Gas # Electrical # `� Integral Make Up Air Shut Down 13•Yes ❑ No i U c' Cylinder Size(s) & Qty �, c l Last Hydrostatic Test Date(s) �- L/ c Flow Points: Capacity �r Used 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 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 State E Fe- MaFshal A FS 20 Test Form 1012010 a' : f `fit r,�► , . Inspection, Testing, and Maintenance t _,_.) I k j .(__A V — A€S20 Page 2 of ` Wet Chemical Pre-Engineered F ire Extinguishing Systems - Title 19 Chapter 5 § 904.7 Address:! Property Dater A- J System Location System / of . r � t contractor Name: JORGENSEN COMPANY Item Frequency Description NFPA 17A (unless noted) Fail N/A Pass 1 -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) e� 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 l� 1 -1.8 Monthly Hood, Ducts & Protected Cooking Appliances Have Not Been 7 2 2(8) Replaced 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 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 Annually y ll Agent Containers within Acceptable Hydrostatic Test 7,5.1 1 () 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) (� M -1.9 Semi Annually Fixed Temperature Sensing Elements Maintained or CFC 514.2.2 Replaced M -2.0 Semi Annuall y Auxiliary Equipment Such as Water Valves Functioned 7.3.2.1 2 ( ) Correctly 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: /1 � t i System Ins ected;tteste /d and maintained in accordance with manufacturer's written iiin�stt)ructionsand applicable standards (_ T -19 §904.7) IN PASS ❑ FAIL y Technician Signature Date & Time of Service 'Customer Acknowledgement M Inspection, Testing, and Maintenance A€S28 Page 1 of Wet Chemical Pre - Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7 Property Information: Nozzle Appliance Name Name: '4:, Nozzle Nozzle ! Flow Pts Type Address: ='�,�� :�� =ti�: 9. . ��'� r JORGENSEN COMPANY Flow Pts City: 2691 South East Ave. System °�` Fresno, CA 93706 of ZIP: "' C16 Lic. # 262995 Contact: - Telephone:_ Service Location: Date: - ❑ 2691 S. East Ave Fresno 800 - 481 -3473 ❑ 1536 Princeton Modesto 800 - 606 -0835 IXPASS Copy sent to: ❑ Owner Date ❑ 2345 S. Fruitvale Bakersfield 877 - 238 -6305 4 ❑ Fire AHJ Date El 3190 Luyung Dr Rancho Cordova 800 - 758 -1124 FAIL 5 Service Technician '.i < ' - '` Owner /Occupant ��_ f;r u , e" Print Name r 1t'r�,� o ? �A, . __ : i _ Print Name t 6 :;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 iC 4' > -C N; i r PC4. System Mfg t -u.� ,r� Model # # Hoods Dimension(s) # Plenums Dimensions(s) '�U D "Standard ❑ V -Bank # Ducts Dimensions(s) s: a L) Fuel /Heat Shut Off: Gas # ' Electrical # Integral Make Up Air Shut Down ❑ Yes ❑ No Cylinder Size(s) & Qty" Last Hydrostatic Test Date(s) Flow Points: Capacity f " 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 1 2 - _ - 3 v 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 State FoFe MaFshal AES 20 Test Form 1012010 Inspection, Testing, and Maintenance AES2 A Page 2 of "u Wet Chemical Pre-Engineered Fire Extinguishing Systems - Title 19 Chapter 5 § 904.7 Property Address: '= Date: System Location ;C . t System of Contractor Name: JORGENSEN COMPANY Item Frequency Description NFPA 17A (unless noted) Fail N/A Pass 1 -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) i 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) V 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 t f 1 -1.8 Monthly Hood, Ducts & Protected Cooking Appliances Have Not Been 7 2 2(8) f Replaced 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 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 Annually All Agent Containers within Acceptable Hydrostatic Test 7,5.1 1 ( ) " 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) : A, 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) A .� 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 Annuall y Fixed Temperature Sensing Elements Maintained or CFC 514.2.2 ' it Replaced M -2.0 Semi Annuall y Auxiliary Equipment Such as Water Valves Functioned 7.3.2.1(2) t Correctly 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: _.System Inspected;tested/arfd maintained in accordance with manufacturer's written instructions and //applicable standards (T -19 §904.7) Z PASSE , % i �'r�` 11 ICJ ❑ FAIL Technician Signature Date & Time of Service VCustomer Acknowledgement State Ciro Marshal Ar=c 20 Test Form 1012010