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HomeMy WebLinkAbout4721 PLANZ ROADPHOEN iiR PROTECTION' 10,//,ic ? -g 9,, H 2990 PAY FROM THIS INVOICE 210 South Cotta Court Visalia, CA 93292 TEL: (559) 622 -8969 FAX: (559) 622 -9023 L1C # C 16- 779030 Name System Description Porgy Time Address 1 p City Pull Station ........................... ............................... State Zip W Cash 5 3 t j Authorized By: Install Renovation G40 Nozzle Location /Appliance Coverage ................. Range Guard Check# Phone (, Cell L' p Fax d Cylinder Size Visa or Mastercard mail FuJ Links 450F Fuse Links 500E Hydrostatic Testing Fuel Shut -Off Electric Auth # Failures & Recommendations: ro&,,Z c t I r P—) g, n('ff'd, l , , , r1r,c's vtee Thy: iJ&6t' AoOassures that the above. stated services have been rende egaccordingly. I•have been given authority to alloy and approve payment for such tquired gem ;b•the establishment whic s receive this ice and r b authp ed y nt for III rendered. l ?l l n Pe y djfA ply Services ' erformed prior to 30 days of expiration. signature Nozzle Hood Size Date Payment due upon copip9etion Li ksa It; " I . Hood System Report System Description Date of Time A.M. G v tervile g Pull Station ........................... ............................... 11• Annual Semi - Annual Recharge Install Renovation Nozzle Location /Appliance Coverage ................. Range Guard Location of System Cylinder Size Slave Cylinder Size ail &A Fuse Links 3 OF FuJ Links 450F Fuse Links 500E Hydrostatic Testing Fuel Shut -Off Electric Gas Size Failures & Recommendations: ro&,,Z c t I r P—) g, n('ff'd, l , , , r1r,c's vtee Thy: iJ&6t' AoOassures that the above. stated services have been rende egaccordingly. I•have been given authority to alloy and approve payment for such tquired gem ;b•the establishment whic s receive this ice and r b authp ed y nt for III rendered. l ?l l n Pe y djfA ply Services ' erformed prior to 30 days of expiration. signature Nozzle Hood Size Date Payment due upon copip9etion Li ksa It; " I . Hood System Report System Description Date of Time A.M. P.M. tervile g Pull Station ........................... ............................... 11• Annual Semi - Annual Recharge Install Renovation Nozzle Location /Appliance Coverage ................. Location of System Cylinder Size Slave Cylinder Size ail &A Fuse Links 3 OF FuJ Links 450F Fuse Links 500E Other Fuel Shut -Off Electric Gas Size i I Man facturer Model Number Wet Dry Yeo Exhaust Fan .......................... ............................... Productions Date Hydro Date Lanst Sepgrviced P'I° QjCij. Serviced By: Ltl• F d/ iJL_ Type Appl COrl'N o Type ApplTf Type Appl _! Type APpI G Z t' Type APpI Type Appl 10 a Distance tr:- Distance " Distance`' Distance N Distance 6 Distance Nozzle l 9 0 Nozzle ' Nozzle = Nozzle ) Nozzle f Nozzle _ Item Inspected Pull Station ........................... ............................... 11• Gas Valve / Electrical Cutoff . ............................... Nozzle Location /Appliance Coverage ................. TankHydro ........................... ............................... Tank..................................... ............................... ControlHead ........................ ............................... Braketing. ............................ ............................... Fuse Links eplaced leaned ....................... Systems Installed to Mfctr's Recommendations.. I S MFilter ..................................... ............................... Exhaust Fan .......................... ............................... Makeup Air .......................... ............................... UL300 .................................. ............................... Filters - Baffle Style .............. ............................... CIass . ............................... Ltl• SIC fDc1AonrLine System Monitored By: Yes No PH# AV91aae, ° Hood & Duct ........................ ............................... t- --111 Other..................................... ............................... Other..................................... ............................... iJL_ Type Appl COrl'N o Type ApplTf Type Appl _! Type APpI G Z t' Type APpI Type Appl 10 a Distance tr:- Distance " Distance`' Distance N Distance 6 Distance Nozzle l 9 0 Nozzle ' Nozzle = Nozzle ) Nozzle f Nozzle _