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Home My WebLink About1201 24TH Street (2)P F_ Simp/exGrinne// BE SAFE. ATyco International Company ° RANGE HOOD SYSTEMS REPORT 2788 N. !Arkin Avanue 0101 Fmn% CA 93727 UG.0 802691 P 559 - 348-0614 F 558 -M8 -1281 -1 Customer FLA-yV V_ Address Attention S h CIA, Phone Fax ( ) Date of Service Z y- Time I AN] _ PM 14- r I 2. /}� if Annual Semi - Annual Recharge Installation Renovation Other Proper separation between fryers and flame 4. System installed in accordance w /Mfg UL listing •0 <6 22. Proper clearance -flame to filters ' L ion of System Cylinders i- Si %-`X Manuf cturer Model Wet Dry Chemical Q-1-9 el- 25. All filters reinstalled 7. ylinder Size (Master) Cylinder Size (Slave) Cylinder Size (Slave) /�' ,Pt L" 1 -2) G A- L_ Pressure gauge in proper range (if gauged) Fuse Links 360 °F Fuse Links 450 °F Fuse Links 500 °F Other Qty. Qty. Qty. Replace systems covers Fuel Shut Off Electric Gas Size '0.5 ca-5 I ,!�>S Serial Number If Last Flydro Test Date Last Recharge Date Operate system from terminal link %(O! 30. COOKING APPLIANCE SIZES (NOTE: List appliances from left to right and indicate nozzles used for.. each) Plenum Size(s) t3 f 1 N /61 /6 zy 1 C�), " ,jT_ 2. Duct and plenum covered w /correct nozzles if ,Duct Size(s) f Z 2 q- X A / Z w Z I � Al P-/ - P#q _ ,n/ ( 2 1. All appliances properly covered w /correct nozzles 19. Check travel of cable nuts /S -hooks 2. Duct and plenum covered w /correct nozzles if 20. Piping and conduit securely bracketed 3. Check positioning of all nozzles i 21. Proper separation between fryers and flame 4. System installed in accordance w /Mfg UL listing •0 <6 22. Proper clearance -flame to filters ' 5. Hood /duct penetrations sealed w /weld or UL device t-) 23. Exhaust fan operating properly 6. Check if seals intact, evidence of tampering ; Q-1-9 el- 25. All filters reinstalled 7. If system has been discharged report same ' I 25. Fuel shut -off in ON position 8. Pressure gauge in proper range (if gauged) 26. Manual and remote set/seals in place 9. Check cartridge weight (replace, if needed) 27. Replace systems covers 10. Hydrostatic /6 year maintenance date 28. System operational and seals in place 11. Inspect cylinder and mount 29. Slave system operational 12. Operate system from terminal link %(O! 30. Clean cylinder and mount 13. Test for proper operation from remote q AOS 31. Fan warning sign on hood 14. Check operation of micro switch `s 32. Personnel instructed in manual operation of system 15. Check operation of gas valve 33. Proper hand portable extinguishers 16. Proper nozzle covers in place /clean nozzles (K Class and ABC) 17. Check fuse links and clean 34. Portable extinguishers properly serviced 18. Replaced fusible links (record date here) eLz7 35. Service and certification tag on system NOTE DISCREPANCIES R DEFICENCIES SY �' i 19 Nt �C �� i �/ A V IMPORTANT NOTICE TO CUSTOMER TOTAL SERVICE Customer acknowledges and agrees to the terms and conditions on the reverse side of this Range Hood Systems Report, agrees that the services have been completed to Customer's satisfaction and that the system is in good working order and repair, unless services TOTAL SALES performed were of a temporary nature, in which case Customer acknowledges that part of customer's system may have been bypassed or is otherwise inoperable until service can be completed. LABOR or FRT or CUSTOMER'S APWN.TION IS DIRECTED TO THE LIMITATION OF LIABILITY, WARRANTY, INr,// - TRIP CHARGE AND OTHER CONDITIONS ON THE REVERSE SIDE. Acceptance of customer or customer's representative GRAND TOTAL TECHNICIAN COPY 6 l2aS © SimplexGrinnell LLP 2008, All Rights Reserve -..,- SG0720 R2 (09164)''