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Home My WebLink About123 18 STREETRange Hood `y; ) : fie•. • l elG SERVICE COMPANY DATE OF SERVICE 20. Replaced fuse links TIME 2. Duct and plenum covered w /correct nozzles i 4 P.M. ANNUA SEMI - ANNUAL RECHARGE INSTALLATION RENOVATION tiR C17,1.1-,1711 CCI.74Mrm ro opt r ppN;3OU v' 24. Proper clearance -flame to filters 6. Check if seals intact, evidence of tampering LOCATION OF SYSTEM CYLINDERS UL 300 AYES NO MANUFACTURER MODEL NUMB R WET 8. Pressure gauge in proper range (If gauged) DRY CHEMICAL 27. Fuel shut -off in on position 9. Check cartridge weight (If applicable) 28. Manual & remote set/seals in place, CYLINDER SIZE MASTER CYLINDER SIZE SLAVE 29. Replace systems covers CYLINDER SIZE SLAVE 11. 6 year maintenance date v ; 30. System operational & seals in place 12. Inspect cylinder and mount FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER CUSTOMER Name r FUEL SHUT -OFF ELECTRIC GAS SIZE Address 16. Check operation of gas valve 35. Proper hand portable extinguishers 17. Clean nozzles City n -. ci State ZIP 7 o SERIAL NUMBER LAST HYDRO TEST DATE f% - / 18. Proper nozzle covers in place LAST RECHARGE DATE MANUFACTURER'S MANUAL REFERENCE 19. Check fuse links and clean r Telephone _ Ci, /- Store No. NOTE DISCREPANICES OR DEFICIENCIES BELOW PAGE NUMBER: DRAWING NUMBER: DATE Owner or Manager COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT 1. All appliances properly covered w /correct nozzles 20. Replaced fuse links 2. Duct and plenum covered w /correct nozzles i 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 T A ! 26. All filters in place 8. Pressure gauge in proper range (If gauged) r 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 v ; 30. System operational & seals in place 12. Inspect cylinder and mount 31. Slave system operational 1 f 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 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 fl 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. X SERVICE'TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMER'S AW HORIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. Range Hood Systems Report CA 0307 ;7; C v) u33 -5510 FAX K;,`0-,',31 2 CUSTOMER Name /z L A.M. P.M. 1. All appliances properly covered w /correct nozzles O GIINSTALLATION 20. Replaced fuse links Address 42.3 E RECHARGE 21. Check travel of cable nuts /S -hooks City l Yr Lo State /)Z_ ZIP Telephone Store No. Owner or Manager COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT r, 1. DATE OF SERVICE TIME A.M. P.M. 1. All appliances properly covered w /correct nozzles O GIINSTALLATION 20. Replaced fuse links ANNUAL SEMI - ANNUAL RECHARGE 21. Check travel of cable nuts /S -hooks RENOVATION LOCATION OF SYSTEM CYLINDERS UL 300 11 9YES NO C r r 1" 1 MANUFA&TURER MODEL NUMBER WET DRY CHEMICAL Z 24. Proper clearance -flame to filters 6. Check if seals intact, evidence of tampering f 25. Exhaust fan in operating order CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE S 8. Pressure gauge in proper range (If gauged) FUSE LINKS 360°'17. FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER 28. Manual & remote set/seals in place 10. Hydrostatic test date FUEL SHUT-OFF ELECTRIC GAS/ SIZE S 30. System operational & seals in place 12. Inspect cylinder and mount SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE MANUFACTURER'S MANUAL REFERENCE PAGE NUMBER: DRAWING NUMBER: DATE 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. DATE: TIME: AM PM CUSTOMER'S A 17. RIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. 1. 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 1 23. Proper separation between fryers & flame 5. Hood /duct penetrations sealed w /weld or UL device Z 24. Proper clearance -flame to filters 6. Check if seals intact, evidence of tampering f 25. Exhaust fan in operating order 7. If system has been discharged, report same A4&- 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 S 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 24 34. Personnel instructed in manual operation of system 16. Check operation of gas valve if 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 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. DATE: TIME: AM PM CUSTOMER'S A 17. RIZED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.