HomeMy WebLinkAbout1419 BRUNDAGE LANERange Hood Systems Report
Pu .a-Pr3'•.9v,ctl P d . °.p PA B^° 3, C, W ,O.
n
J33 -5;;10 FAX 830 -55112
p
CUSTOMER
Name -r l_ Ian i /
I_
I '
v
Address
city - A 1 1 r /. _State(" -
ZIPS
TelephoneT2 z- ! azz Store No.
Owner.,or Manager .
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
DATE OF SERVICE TIME A.M. P.M.
ANNUAL SEMI-'ANNUAL RECHARGE INSTALLATION RENOVATION
3. Check positioning of all nozzles. 22. Piping & conduit securely bracketed
4. System installed in accordance w /MFG UL listing
LOCATION OF SYSTEM CYLINDERS
23. Proper separation between fryers & flame
U300
MANUFA TURER MODEL NUMBER r, ' WET •' DRY CHEMICAL
25. Exhaust fan in operating order
7. If system has been discharged, report same
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE
8 Pressure gauge in proper range (If'gauged)
CYLINDER SIZE SLAVE
L/
91. Check cartridge weight (If applicable) 28. Manual & remote set/seals in place
FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500°
29. Replace systems covers
11. 6 year maintenance date 30. System operational & seals in place
FUEL SHUT-OFF ELECTRIC GAS SIZE
SERIAL NUMBER LAST HYDRO TEST DATE
32. Clean cylinder & mount
LAST RECHARGE DATE
MANUFACTURER'S MANUAL REFERENCE
33. Fan warning sign on hood
PAGE NUMBER: DRAWING NUMBER: DATE
G
20. Replaced fuse links1. All appliances properly covered w /correct nozzles 20. Replaced fuse links
2. Duct and plenum covered w /correct nozzles 21. Check travel of cable nuts /S -hooks
3. Check positioning of all nozzles. 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 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
91. Check cartridge weight (If applicable) 28. Manual & remote set/seals in place
110. Hydrostatic test date 29. Replace systems covers
11. 6 year maintenance date 30. System operational & seals in place
12. Inspect cylinder and mount 31. Slave system operational
13. Operate system from terminal link 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 s
16. Check operation of gas valve 35. Proper hand portable extinguishers
17. Clean nozzles 36. Portable extinguishers properly serviced T
18. Proper nozzle covers in place 37. Service & Certification tag on system
19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW
COMMENTS:
On this date, this range hood fire suppression system was inspected and operationally tested in accordance 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 A E: TIM AM PM CUSTOMER'S AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
AUTHORUTV HAVURU0 JUWUSDICY 0H