HomeMy WebLinkAbout2031 WHITE LANEJORGENSEN CO
STATE FIRE MARSHAL A -0309
CONTRACTORS LICENSE C 16 C 10 C7
OBAKERSFIELD (661) 3274352
❑FRESNO
AMERCED
OMODESTO
Name: SG ),j \.(_.
(559) 268 -6241
(209) 383 -6647
(209) 529 -0835
Address: C3\ LJ\j
Jurisdiction: C, r� \
Code:
RANGE HOOD SYSTEM REPORT
I 1 �)'l q'1 L-{ PIN I D
DATE GS{�RVICE
�. (0
3 .r rev
T ME
lC) `, �
5
A.M.
1
P:iN.
MANUFACTURER
MODEL NUMBER
(:5�
DRY
CYLINDER SIZE MASTER
OTHER CYLINDER
LOCATION OF GAS VALVE
-C
- , 0
CL
iL I vC.
FUSE LINK
FUSE LJNK
FUSE LINK
500
OTHER
LINKS
REPLACED
FUEL SHUT -
`
QTY.
430 QTY.
QTY.
-
NO
OFF
TE STED
ELECTRIC
NO
MANUAL PULL OPERABLE
DETECTION L NE
ALL NOZZLES REMOVED, CLEANED PER J CO
NO
OPERABLE/UNF'RAYED
NO
A MANUFACTURES
SPECIFICATIONS
YES NO
LOCATION OF SYSTEM
ANSUL SEAL CART.
, j ���••++. ` (
YES
NO
HOOD
DUCT
MANAGER'S
PHONE
NAME
NUMBER
COOKING APPLIANCES LOCATION: LEFT TO RIGHT WITH SIZES
?SPORT EACH SYSTEM WFM ANY OF THESE PROBLEMS:
❑ Additional nozzles are required for:
❑ Electric or Gas cut-off must be installed to prevent a fire from
reigniting per N.F.P.A. 96,17 &17A codes.
❑ Additional fire detector's are required to assure reliable fire
detection.
❑ This system is designed for coverage with no more than a fight grease
buildup. Crease buildup appears excessive. We recommend the exhaust
system be professionally cleaned. Initials
❑ Because of the age and/or condition of this fire control system it may
1. Are all external hood penetrations sealed, welded.or- sealed /
with a UL device? �.. S NO
2. Is pressure gauge in operable range? 'jl -A- YES—NO
3.: Record 6 year maintenance due date.
4. Record Hydrostatic due date. �Dz z
5. Record 12 Year regulator test due date. �G
6. Are cartridge's weights within acceptable limits? QES NO
7:'/'Is the proper extinguisher in place and serviced? S NO
8" Are the exhaust fans working? _ all S NO
9. Next due date for extinguisher service. `- 0 .
10. Next due date for extinguisher hydro.
11. Is this system a U.L. 300?
YES
fail and should be replaced with a new system. Initials ❑ With the introduction of Vegetable oil in place of animal fat, U.L. `
has changed
re it's standard to extinguish grease fires. We understand you
❑ ON THIS DATE CUSTOMER WISHES NOT TO HAVE THIS a using this type of oil. We recommend upgrading to the new standard
SYSTEM SERVICED. to assure you have the proper fire protection Initials
Comments: h K k-J S V S 714JI11 ),40 11 C• S +_Xj1 DG w .N R Jv D
On this) date the above i stem w4s inspected in accordance with the
State Fire Marshall re ations„t e manufacturer's manual, and
SERVICE
I have been instructed on and understand the operation of this system.
CUSTOMER'S AUTHORIZED AGENT
The above service tech, cian certifies that the system was personally inspected and found conditions to be as indicated in this report.
WHITE - CUSTOMER COPY .CANARY - JORGENSEN PINK - AUTHORITY HAVING JURISDICITON
Z
3 .r rev
V E (Z.
5
6
7
8 1.
?SPORT EACH SYSTEM WFM ANY OF THESE PROBLEMS:
❑ Additional nozzles are required for:
❑ Electric or Gas cut-off must be installed to prevent a fire from
reigniting per N.F.P.A. 96,17 &17A codes.
❑ Additional fire detector's are required to assure reliable fire
detection.
❑ This system is designed for coverage with no more than a fight grease
buildup. Crease buildup appears excessive. We recommend the exhaust
system be professionally cleaned. Initials
❑ Because of the age and/or condition of this fire control system it may
1. Are all external hood penetrations sealed, welded.or- sealed /
with a UL device? �.. S NO
2. Is pressure gauge in operable range? 'jl -A- YES—NO
3.: Record 6 year maintenance due date.
4. Record Hydrostatic due date. �Dz z
5. Record 12 Year regulator test due date. �G
6. Are cartridge's weights within acceptable limits? QES NO
7:'/'Is the proper extinguisher in place and serviced? S NO
8" Are the exhaust fans working? _ all S NO
9. Next due date for extinguisher service. `- 0 .
10. Next due date for extinguisher hydro.
11. Is this system a U.L. 300?
YES
fail and should be replaced with a new system. Initials ❑ With the introduction of Vegetable oil in place of animal fat, U.L. `
has changed
re it's standard to extinguish grease fires. We understand you
❑ ON THIS DATE CUSTOMER WISHES NOT TO HAVE THIS a using this type of oil. We recommend upgrading to the new standard
SYSTEM SERVICED. to assure you have the proper fire protection Initials
Comments: h K k-J S V S 714JI11 ),40 11 C• S +_Xj1 DG w .N R Jv D
On this) date the above i stem w4s inspected in accordance with the
State Fire Marshall re ations„t e manufacturer's manual, and
SERVICE
I have been instructed on and understand the operation of this system.
CUSTOMER'S AUTHORIZED AGENT
The above service tech, cian certifies that the system was personally inspected and found conditions to be as indicated in this report.
WHITE - CUSTOMER COPY .CANARY - JORGENSEN PINK - AUTHORITY HAVING JURISDICITON