HomeMy WebLinkAbout4721 PLANZ LANEPHOENIX FIRE
PROTECTION 2125
PAY FROM THIS INVOICE
210 South Cotta Court
Visalia, CA 93292
TEL: (559) 622 -8969
FAX: (559) 622 -9023
LIC # C 16- 779030
Name I"
System Report
System Descripflo m
Date of Service
3:
l 1
Address
P.M.
7
City -; State, Zip;
Cash
Authorized By:
mar
Semi - Annual Recharge Install
Check# _
Vis orQlgstgr¢grd)
Ifhone }1 / Cellf . Fax
El
Email
Cylinder Size Slave
Gas Valve / Electrical Cutoff . ............................... Ell
i. ut4 .a Z'
Description ofAutomatic system
System Report
System Descripflo m
Date of Service
3:
l 1
A.M. P.M.
Item Inspected
Range Guard
mar
Semi - Annual Recharge Install
1s`> + °:i „• II
Pull Station ........................... ............................... El
Hydrostatic
Cylinder Size Slave
Gas Valve / Electrical Cutoff . ............................... Ell
i. ut4 .a Z'
Hood. System Report
System Descripflo m
Date of Service Time A.M. P.M.
Item Inspected
Annual Semi - Annual Recharge Install Renovation
Pull Station ........................... ............................... El
Location of System Cylinder Size Slave
Gas Valve / Electrical Cutoff . ............................... Ell
Fire Extinguisher Size
Cylinder Size
Nozzle Location /Appliance Coverage .................
Fuse Links 360F Fuse Links 450F Fuse Links 56OF Other
Tank Hydro ........................... ...............................
Fuel Shut -Off Electric Gas Size
Manufacturer Model Number Wet Dry
Credit Surcharge
Production Date
Control Head ........................ ...............................
Hydro Date Last Serviced
Braketing.............................. ...............................
Serviced By.,, !
Ii• I ( 1 ., Fuse Links - Replaced or Cleaned, ......................
Services performed prior to 30 days of expiration.
Signatute 1 Date `-
Payment due up ®n completion.
Hood
Size
Nozzle Links
Type Appl . Type Appl Type Appl Type Appl Type Appl Type Appl
Distance Distance Distance Distance Distance Distance
Nozzle Nozzle Nozzle Nozzle Nozzle Nozzle
Blow Off Caps /Seals
eD
Item Inspected
Qasp
a
G000
Pressurized Cartridges Pull Station ........................... ............................... El
Gas Valve / Electrical Cutoff . ............................... Ell
Fire Extinguisher Size
Nozzle Location /Appliance Coverage .................
Nitrogen Tank Hydro ........................... ...............................
Tank ..................................... ...............................
Credit Surcharge Control Head ........................ ...............................
Braketing.............................. ............................... Ii• I ( 1 ., Fuse Links - Replaced or Cleaned, ...................... 0.
Systems Installed to Mfctr's Recommendations..
Filter ..................................... ............................... E . El
Failures & Recommendations: Exhaust Fan .......................... ...............................
Makeup Air ......................................................... El' El El
UL 300 .................................. ............................... El.
Filters - Baffle Style .............. ............................... 0'-
K- Class ................................. ............................... E'.
Detection Line ...................... ............................... Q',
System Monitored By: Yes NoD. The signature below assures that the above stated services have been rendered accordingly. I have
been given authority to allow and approve payment for such required services by the establishment PH #
Hood & Ductwhichhasreceivedthisserviceandherebyauthorizedpaymentforallservicesrendered.
Other..................................... ............................... El El
Services performed prior to 30 days of expiration.
Signatute 1 Date `-
Payment due up ®n completion.
Hood
Size
Nozzle Links
Type Appl . Type Appl Type Appl Type Appl Type Appl Type Appl
Distance Distance Distance Distance Distance Distance
Nozzle Nozzle Nozzle Nozzle Nozzle Nozzle