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HomeMy WebLinkAboutFIRE SUPPRE. SYSTEM REP. 9/26/2012Pre - Engineered Restaurant Fire Suppression Systems Report SERVICE COMPANY l QUALM SERVICES, INC. 5600 SO. UNION 3AKERSFIELD, CA 93307- -5426 RIS-11 833 -5510 FAX 633 -5512 7 y Name G' /C /O -_J Address i5541?22/ Zy_ City Y6 iJ _- Stato ZIP ,z Telephone 617'/ - '25 % © Store No. Owner or Manager DATE OF S RVICE TIME A.M. P.M. 9 26 i2 ANNUAL SEMI - ANNUAL RECHARGE INSTALLATION RENOVATION LOCATION OF SYSTEM CYLINDERS UL 300 7-C11,1-1V VYES E] NO MANUFACTURER MODEL NUMBER WET DRY CHEMICAL CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE Z 46,G r--- FUSE LINKS 360° F. FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER FUEL SHUT -OFF ELECTRIC GAS SIZE b--r iE SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE MANUFACTURER'S MANUAL REFERENCE PAGE NUMBER: DRAWING NUMBER: DATE COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT V' 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 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 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. E TECHNICIAN 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. GJt9YHOR11TY GAMING JURISDICTIOM