HomeMy WebLinkAbout2517 WHITE LANElPre ®Engineered Restaurant Fire Suppression Systems Report
COMPANY
E: :,0 S0. UN; IIIIJ
CA 93307-5426
o s33 -5510 FAX 333 -5512
1k
V
CUSTOMER
Name Z1'21C iC 1// by1 1
Address
City 6q)C4,& / I,e State 1 ZIP ?
Telephon4Wr- 7/l Store No.
Owner or Manager Al
DATE OF SERVICE TIME
U G
A.M.e' P.M.
21. Check travel of cable nuts /S -hooks
ANNUAL SEMI - ANNUAL. RECHARGE INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS L 300
21ES NO
1,
24. Proper clearance -flame to filters
MANUFAG URER M DEL NUMBER WET DRY CHEMICAL
9Nr0_4_ x // 43 6,70 0
26. All filters in place
CYLINDER SIZE MASTER CYLINDERCYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
k
9. Check cartridge weight (If applicable)
FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER
29. Replace systems covers
2-
11. 6 year maintenance date
12. Inspect cylinder and mount
FUEL SHUT -OFF ELECTRIC GAS SIZE
L 32. Clean cylinder & mount
14. Test for proper operation from remote
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
MANUFACTURER'S MANUAL REFERENCE'
PAGE NUMBER: DRAWING NUMBER: DATE
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
20. Replaced fuse links
21. Check travel of cable nuts /S -hooks
3. Check positioning of all nozzles.
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 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 f
10. Hydrostatic test date 29. Replace systems covers Z
11. 6 year maintenance date
12. Inspect cylinder and mount L
30. System operational & seals in place
31. Slave system operational Z .
13. Operate system from terminal link L 32. Clean cylinder & mount
14. Test for proper operation from remote G' 33. Fan warning sign on hood l
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 Z' 37. Service & Certification tag on system
19. Check fuse links and clean 44 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.
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PERMIT NO. DATE TIME: AM PM /G(
The above service technician certifies that the system was personally inspected and found conditions to be as in
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AUTHORITY HAVING JURISDICTION
a
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r
ED AGENT
on this report.