HomeMy WebLinkAboutHOOD INSP 11/11/2010Range Hood Systems Report
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AnA Cads ITY rru L L , INC.
5300 SO. Ufa! :CN
EAKL DP=1cLD, CA 93307 -5426
6tu1) 633 -5510 FAX 833 -5512
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CUSTOMER
Name -"V,_ \
Address 5 U7 1
City " S \: TV
States ZIP
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Telephone Store No.
Owner or Manager
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
DATE OF SERVICE
20. Replaced fuse links
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21. Check travel of cable nuts /S -hooks
A.M. P.M.
1 -1I- 10
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
1
25. Exhaust fan in operating order `
ANNUAL SEMI - ANNUAL RECHARGE INSTALLATION RENOVATION
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
LOCATION OF SYSTEM CYLINDERS
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32. Clean cylinder & mount
UL 300
2-YES NOtj -VI J C.' 10 tlVIL 00
34. Personnel instructed in manual operation of system
16. Check operation of gas valve
MANUFACTURER MODEL NUMBER WET
18. Proper nozzle covers in place
DRY CHEMICAL
19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW
COMMENTS:
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
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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 indi ated above.
FUSE LINKS 360° F. FUSE LINKS 450° F
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FUSE LINKS 500° F. OTHER
FUEL SHUT-OFF ELECTRIC GAS SIZE
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
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rPAGE FACTU RER'S MANUAL REFERENCE
NUMBER: DRAWING NUMBER: DATE
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
1
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) A., 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
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 o 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 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 indi ated above.
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SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM STOMER'S AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.