HomeMy WebLinkAbout3200 GOSFORD ROADPre - Engineered Restaurant Fire Suppression Systems Report
SERVICE COMPANY /
7
GM QUALM SERVICES, INC.
5800 SO. UNION
BAKERSFIELD, CA 93307 -5426
661 ) 833-5510 FAX 833 -5512
CUSTOMER
Name 44 .4 - i
Address /e_*::7 i/ I / '/
city State a 2z /
Telephone EZ202- 12: eECE Store No.
Owner or Manager ? rz'._ r =Zu"a/
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
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 i
19. Check fuse links and clean
DATE OF SERV E TIME A.M. P.M.
ANNUAL SEMI- ANNUAL 1. RECHARGE INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS UL 300
OF llalaD //I/ /T- YES C] NO
MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
2_5,;::;_,91_
FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER
FUEL SHUT -OFF ELECTRIC GAS SIZE
SERIAL NUMBER LAST HYDROTEST DATE LAST RECHARGE DATE
OO
MANUFACTURER'S MANUAL REFERENCE
PAGE NUMBER: DRAWING NUMBER: DATE
COMMENTS: 44_7-' 41
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
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:'
8ERVICC14NICIAN PERMIT NO. DATE: TIME: AM PM C08TOMER7AUT1-16RIZED 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