HomeMy WebLinkAbout1419 19TH STREETRange Hood Systems Report
SERVICE COMPANY
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DATE OF SERVICE
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TIME
11,L,
A.M. P.M.
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ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS
8. Pressure gauge in proper range (If gauged)
UL 300
5300 SO. UNION
BAKERSFELD, CA 93307 -5426
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YES RNO
MANUFACTURE
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MODEL NUMBER WET DRY CHEMICAL
667) 833 -5510 FAX 833 -5512 RCYINDERZIZEMASTER 1-!
CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
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VVV 111
FUSE LINKS 360° F. FUSE LINKS 450° F 71NKS 500° F OTHER
CUSTOMtR
Name AI Ti ,Gv
Address
FUEL SHUT -OFF ELECTRIC GAS SIZE `
SERIAL NUMBER LAST HYDROTEST DATE LAST RECHARGE DATE
City / /I 1 Lf State ZIP v.
MANUFACTURER'S MANUAL REFERENCE
Telephone Store No.
PAGE NUMBER: DRAWING NUMBER: DATE
Owner or Manager
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
1. All appliances properly covered w /correct nozzles
2. Duct and plenum covered w /correct nozzles
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3. Check positioning of all nozzles.
4. System installed in accordance w /MFG UL listing
5. Hood /duct penetrations sealed w /weld or UL device I
6. Check if seals intact,, evidence of tampering
7. If system has been discharged, report same
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8. Pressure gauge in proper range (If gauged)
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9. Check cartridge weight (If applicable)
10. Hydrostatic test date
11 6 year maintenance date
12. Inspect cylinder and mount a
1`3. Operate system from terminal link
14. Test for proper operation from remote
15. Check operation of micro switch
16. Check operation of gas valve
17. Clean nozzles
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18. Proper nozzle covers in place I
19. Check fuse links and clean
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UL5 CCOMMENTS: S J
20. Replaced fuse links
21. Check travel of cable nuts /S -hooks
22. Piping & conduit securely bracketed
23. Proper separation between fryers & flame
24. Proper clearance -flame to filters
25. Exhaust fan in operating order "
26. All filters in place
27. Fuel shut -off in on position
28. Manual & remote set/seals in place
29. Replace systems covers
30. System operational & seals in place
31. Slave system operational
32. Clean cylinder & mount
33. Fan warning sign on hood
34. Personnel instructed in manual operation of system
35. Proper hand portable extinguishers
36. Portable extinguishers properly serviced
37. Service & Certification tag on system
NOTE DISCREPANICES OR DEFICIENCIES BELOW
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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.
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SERVICE TECHNICIANNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMER'S AUTHORIZED AGENT
above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.