HomeMy WebLinkAboutFIRE SUPPR. SYSTEM REP. 3/20/2012Pre - Engineered Restaurant Fire Suppression Systems Report
t::10 FrYh
le4/1 12
Name
Address ZA/ .
City State_
Telephone Q5" 2/7 / Store No.
Owner or Manager /J
DATE OF SE VICE TIME
X69. ,O0
A.M. P.M.
20 // 2-
ANNUAL SEMI - ANNUAL I RECHARGE INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS UL 300
YES E] NO
MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER
3
FUEL SHUT -OFF' ELECTRIC GAS SIZE
2-
SERIAL NUMBER LAST HYDRO TEST DATE LASTRECHARGE DATE
MANUFACTUREITS MANUAL REFERENCE
PAGE NUMBER: DRAWING NUMBER: DATE
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
1
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 -It-
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) 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 34. Personnel instructed in manual operation of system
16. Check operation of gas valve 35. Proper hand portable extinguishers
17. Clean nozzles J_ 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
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.
SERVICE
TI
CRNIICIAN PERMIT NO. DATE: 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.
AU =0MV bMMIG JURISDICTION