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Range Hood Systems Report
SERVICE COMPANY DATE OF SERVICE TIME
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A.M.
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ANNUL SEMI_ ANNUAL RECHARGE INSTALLATION RENOVATION
22. Piping & conduit securely bracketed
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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
LOCATION OF SYSTEM CYLINDERS
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MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
CYLINDER SIZE MASTER
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CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
26. All filters in place
FUSE LINKS 360° F.
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FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER
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CUSTOMER
Name l'i/l ] ` ((
1111
FUEL SHUT -OFF ELECTRIC GAS SIZE
Address - i eQ
29. Replace systems covers
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City, _+ r\A State ZIPT,77-,
SERIAL NUMBER 17T HYDROTEST DATE LAST RECHARGE DATE
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Telephone ZA D 79 Store No.
MANUFACTURER'S MANUAL REFERENCE
13. Operate system from terminal link
PAGE NUMBER: DRAWING NUMBER: DATE
Owner or Manager i 4L n, ) ri n2COOKINGAPPI_ IANCF I nCAT/nNS- 1 FFT Tn PIGHT
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2. Duct and plenum covered w /correct nozzles 21. Check travel of cable nuts /S -hooks
1. All appliances properly covered w /correct nozzles 1/ 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. 7 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) Z 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
12. Inspect cylinder and mount 31. Slave system operational A
13. Operate system from terminal link 32. Clean cylinder & mount
14. Test for proper operation from remote 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 f l 36. Portable extinguishers properly serviced
18. Proper nozzle covers in place 2/ 37. Service & Certification tag on system
19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW
COMMENTS:
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.
SERVICE TECHNICIAN PERMIT NO. ATE: TIME: AM PM CUSTOMER'S AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
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