HomeMy WebLinkAboutFIRE SUPP. SYSTEM 8/18/2011Pre-Engineered Restaurant Fire Suppression Systems Report
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5300 SO. ILIMON
D ". "7 , ; GELD; CA 93307 -5426
6ji) 833 -5510 FAX 833 -5512
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CUSTOMER
Name
Address <af i/ Azz
City -)ri ff 0 State ZIP
Telephone Store No.
Owner or Manager
COOKING APPLIANCF LOCATIONS- f FFT TO RIGHT
DATE OSERVICE TIME A.M. P.M.
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21. Check travel of cable nuts /S -hooks
3. Check positioning of all nozzles.
ANNUAL SEMI- ANNUAL RECHARGE INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS UL 300
S,Z) kA (y ( &C ill 1i YES NO
MANUFACTURER MODEL N MBER WET DRY CHEMICAL
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27. Fuel shut -off in on position
9. Check cartridge weight (If applicable)
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
29. Replace systems covers
11. 6 year maintenance date
FUSE LINKS 360° F FUSE LINKS 450° F. FUSE LINKS 500° F. OTHER
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
FUEL SHUT -OFF ELE • RIC GAS SIZE'
35. Proper hand portable extinguishers
17. Clean nozzles 36. Portable extinguishers properly serviced !
SERIAL NUMBER LAST HYDRQ TEST DATE LAST RECHARGE DATE
MANUFACTURER'S MANUAL REFERENCE/ J
PAGE NUMBER: DRAWING NUMBER: DATE
1., All appliances properly covered w /correct nozzles 20. Replaced fuse links
2. Duct and plenum covered w /correct nozzles 1 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 i 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 DISCREPANICf ES OR DEFICIENCIES BELOW `
Ca ! LN, I /'"nCOMMENTS: r m f°1( ftn A 94 ,f d
On this date, this pre- engineered fire suppression system was inspected and operationally testefd in accordance with the fire
suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results indicated above.
X
ICIAN PERMIT NO. TIME: AM PM AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
AUTHORITY HAVING JURISDICTION