HomeMy WebLinkAbout1701 NEW STINE ROAD (2)Pre- Engineered Restaurant Fire Suppression Systems Report
P 'lei -
Name
Address 12 0 1 M0- S
City 'tip, K State ZI Pg g
Telephone ;' - 12-7 Store No.
Owner or Manager
DATE OF SERVICE TIME A.M. P.M.
Z -Z1i - 17 2) : IS- I tl " I
ANNUAL SEMI - ANNUAL RECHARGE INSTALLATION RENOVATION
O
5. Hood /duct penetrations sealed w /weld or UL device r
LOCATION OF SYSTEM CYLINDERS UL 300
eYESLa I 0o A ONO
MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
AV3LAG 12 - ! 'D Z
nr
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
28. Manual & remote set/seals in place i
FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER
3 a
30. System operational & seals in place
FUEL SHUT -OFF ELECTRIC GAS SIZE
13. Operate system from terminal link 32. Clean cylinder & mount
I
14. Test for proper operation from remote
sue V
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
06
MANUFACTURER'S MANUAL REFERENCE
PAGE NUMBER: DRAWING NUMBER: DATE
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
20. Replaced fuse links
C'h r, tom,:. r 13 E z r' t , SK,
r
3. Check positioning of all nozzles. 22. Piping & conduit securely bracketed
1. All appliances properly covered w /correct nozzles i/ 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 O
5. Hood /duct penetrations sealed w /weld or UL device r 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 At// 26. All filters in place
8. Pressure gauge in proper range (If gauged) nr 27. Fuel shut -off in on position
9. Check cartridge weight (If applicable) 28. Manual & remote set/seals in place i
10. Hydrostatic test date 29. Replace systems covers
11. 6 year maintenance date 4. 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 faI n
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 f
18. Proper nozzle covers in place 37. Service & Certification tag on system
19. Check fuse links and clean IV NOTE DISCREPANICES OR DEFICIENCIES BELOW
COMMENTS:'1L22,a NOr,,'N obe AA,AAr IN) 6- e
M lci l i P /A Lt 1 t N1 c + ', n 11 k ,.•. , v t..) fi_e c.,_v_L P
On this date, this pre- engineered 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. DATE: TIME: 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.
GJM`i Nffl07V HAVI)MG JURISDICTION