HomeMy WebLinkAboutREST. FIRE SUPP. SYST. REP. 5/14/2012Pre - Engineered Restaurant Fire Suppression Systems Report
f n q n°aq «,r r• -rte ^n^
rl ICTnRAGG
Name \.A-10 I - ry tg IZ: -
Address -2 (e3 (-I t=CA ' h .1 2 / !mil
City E k rt D State ZIP a33D
Telephone %6J 82 _5 - 7 O Store No.
Owner or Manager
DATE OF SERVICE TIME A.M. P.M.
5- ly- It 9: / 9
V11,
22. Piping & conduit securely bracketed
ANNUAL SEMI-ANF5TI RECHARGE INSTALLATION RENOVATION
24. Proper clearance -flame to filters
25. Exhaust fan in operating order
LOCATION OF SYSTEM CYLINDERS 300
r , hr o Nooa ESL NO
MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
Ari54, f2 - ioz-
r
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
S 1
li
s " 9 0-.
FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500° F OTHER
FUEL SHUT -OFF ELECTRIC GAS SIZE
36. Portable extinguishers properly serviced
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
2o1I
MANUFACTURER'S MANUAL REFERENCE
PAGE NUMBER: DRAWING NUMBER: DATE
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
E cl e e-
21. Check travel of cable nuts /S -hooks
y 22. Piping & conduit securely bracketed
A_
1 . All appliances properly covered w /correct nozzles
2. Duct and plenum covered w /correct nozzles
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
6. Check if seals intact, evidence of tampering
7. If system has been discharged, report same
8. Pressure gauge in proper range (If gauged)
9. Check cartridge weight (If applicable)
10. Hydrostatic test date
11. 6 year maintenance date
12. Inspect cylinder and mount
13. 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
18. Proper nozzle covers in place
19. Check fuse links and clean
20. Replaced fuse links
21. Check travel of cable nuts /S -hooks
y 22. Piping & conduit securely bracketed
A_ 23. Proper separation between fryers & flame 1
11 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 JX
29. Replace systems covers
y 30. System operational & seals in place S,
y 31. Slave system operational li
32. Clean cylinder & mount
33. Fan warning sign on hood
y 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
COMMENTS: &I C 10& (ij A J 0 `L AJ C,nr j
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.
X
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
AUTHORITY HAVING JURISDICTION
Pre-Engineered Restaurant Fire Suppression Systems Report
r n ^q r° @y ror:.,_n ..R .••r„ ..ate
C,v y t:33 -5510 FAX 3,%7j3- 2
CUSTOMER
Name da I - Mu2x
Address '7 fa 0 1 i- ,, 5 to 'P'
City 74), k G L State CA ZIP fLE
Telephone ( Wo 1 ) !a-7&- -1 I :Z- o Store No. O 2
Owner or Manager
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
0 IssEal: F- I "eo }155ERx E
DATE OF SERVICE TIME A.M. P.M.
S- lN- 1 & 00 I
ANNUAL SEMI- ANNUAL RECHARGE INSTALLATION RENOVATION
1/ I
5. Hood /duct penetrations sealed w /weld or UL device
LOCATION OF SYSTEM CYLINDERS UL 300
L Pk Y e.)C joo J O4ES [] NO
MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
P 2 - 10Z-
8. Pressure gauge in proper range (If gauged)
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
28. Manual & remote set/seals in place
FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500° F OTHER
11. 6 year maintenance date 30. System operational & seals in place V
FUELSHUT -OFF ELECTRIC GAS SIZE
13. Operate system from terminal link
i
32. Clean cylinder & mount
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
V
2x11
MANUFACTURER'S MANUAL REFERENCE
PAGE NUMBER: DRAWING NUMBER: DATE
1. All appliances properly covered w /correct nozzles v 20. Replaced fuse links i
2. Duct and plenum covered w /correct nozzles y 21. Check travel of cable nuts /S- hooks V
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) 28. Manual & remote set/seals in place
10. Hydrostatic test date 29. Replace systems covers
11. 6 year maintenance date 30. System operational & seals in place V
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 V 33. Fan warning sign on hood V
15. Check operation of micro switch 34. Personnel instructed in manual operation of system i'
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 cleans p NOTE DISCREPANICES OR DEFICIENCIES BELOW'
COMMENTS: to d
y
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.
S- E'TECHNICIAN PERMIT NO.. DATE: TIME: AM PM CUSTOMER'S AUTHORIZED. AGENTr
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
A fN000TV GAV(1MG JURISDICTION
fr