HomeMy WebLinkAboutFIRE SUPPRESSION SYS 11/18/2011Pre - Engineered Restaurant Fire Suppression Systems Report
SERVICE
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5300 CO. UN ;3N
DAK°'TIZIIELD, CA 93'c'07 -0,425
A) 833 -5510 FAX 833 -5512
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CUSTOMER
Name &.f7
Address t f ",-t Z2
City State ZIP
Telephone (/ - Store No.
Owner or Manager
COOKING APPLIANCF LOCATIONS- LEFT TO RIGHT
DATE OF SERVICE TIME A.M P.M.
ANNUAL SEMI- NNUAL I RECHARGE INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS 300
1U
UL
VES NO
AN F C MODEL NU B R WET DRY CHEMICAL
gURER
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
CYLIN ER SIZE ASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
FUSELINKS 360* F. FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER
FUEL SHUT -OFF ELECTRIC GAS/ SIZE
9. Check cartridge weight (If applicable) G 28. Manual & remote set/seals in place i
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
11. 6 year maintenance date
MANUFACTURER'S MANUAL REFERENCE
PAGE NUMBER: DRAWING NUMBER: DATE
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20. Replaced fuse links
SERVICE TECHNICIAN' v
PERMIT NO. 10T TIME: AM PM C RIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
AUTHORITY HAVING JURISDICTION
1. All appliances properly covered w /correct nozzles 20. Replaced fuse links
2. Duct and plenum covered w /correct nozzles Z 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
9. Check cartridge weight (If applicable) G 28. Manual & remote set/seals in place i
10. 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 i 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
COMMENTS:
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' v
PERMIT NO. 10T TIME: AM PM C RIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
AUTHORITY HAVING JURISDICTION
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