HomeMy WebLinkAbout1400 WIBLE ROADI
Range Hood Systemo pa?
SERVICE COMPANY
2
e
CUSTOMER
Name
11
C`] 7C CM
Address / 1100 C A LAQ t
city Qr4Ke1- S e State ZIP CI
Telephone C) _ V'7 Store No.
Owner or Manager SZ
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
DATE OF SERVICE TIME A.M. P.M.
iv 0.10 v I L11
ANNUAL SE I- ANNUAL I RECHARGE INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS UL 300
S NO
MXNUFACTUR5R MODEL NUMBER WET DRY CHEMICAL
25. Exhaust fan in operating order
7. If system has been discharged, report same
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
3 C,4 \1C) 3 G( 410 -\ •
0101
FUSE LINKS 360' F FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER
I
29. Replace systems covers
FUEL SHUT -OFF ELECTRIC GAS SIZE
12. Inspect cylinder and mount 31. Slave system operational
13. Operate system from terminal link 1,/'
1
SERIAL NUMBER LAST HYDROTEST DATE LAST RECHARGE DATE
33. Fan warning sign on hood
aZ
15. Check operation of micro switch
MANUFACTURER'S MANUAL REFERENCE
PAGE NUMBER: DRAWING NUMBER: DATE
1. All appliances properly covered w /correct nozzles 7
20. Replaced fuse links l
2. Duct and plenum covered w /correct nozzles 21. Check travel of cable nuts /S -hooks
3. Check positioning of all nozzles. 9%
V
22. Piping & conduit securely bracketed
4. System installed in accordance w /MFG UL listing 23. Proper separation between fryers & flame
5. Hood /duct penetrations sealed w /weld or UL device L1_-
1_
24. Proper clearance -flame to filters
6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order
7. If system has been discharged, report same 26. All filters in place
8. Pressure gauge in proper range (If gauged) 27. Fuel shut -off in on position
9. Check cartridge weight (If applicable) 28. Manual & remote set/seals in place
10. Hydrostatic test date 29. Replace systems covers
11. 6 year maintenance date L7 30. System operational & seals in place
12. Inspect cylinder and mount 31. Slave system operational
13. Operate system from terminal link 1,/' 32. Clean cylinder & mount
14. Test for proper operation from remote 33. Fan warning sign on hood
15. Check operation of micro switch 34. Personnel instructed in manual operation of system
16. Check operation of gas valve 35. Proper hand portable extinguishers
17. Clean nozzles 36. Portable extinguishers properly serviced
18. Proper nozzle covers in place 37. Service & Certification tag on system
19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW k!
COMMENTS:
On this date, this range hood fire suppression system was inspected and operationally ested in acco dance with the fire
suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual, with the results indicated above.
SERVICE TECHNICIAN PERMIT NO. 'DATE: TIME: AM PM ,' CU$TOyMER,S[AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found c' n itions tc e..as- indicatedon this report.
I%UTHORf y HIAVU0 JUGS [ISDtC T[lom