HomeMy WebLinkAbout8110 ROSEDALE HWY (2)JORGENSEN CO
STATE FIRE MARSHAL A -0309
/ CONTRACTORS LICENSE C16 CIO C7
9313AKERSFIELD . (661)3274 352
❑FRESNO (559) 268 -6241
OMERCED .(209) 383 -6647
OMODESTO (209) 529 -0835
Name: )�- % tl /', l /v -
77 3 �A-1
RANGE HOOD'SYSTEM REPORT
Address: / / (���_ ✓(1l-t //I /
City:
Jurisdiction:
Code:
DATE OF SERVICE
T56 /J,-) /
3
4
I ACR
4,1 S L' I 1
MODEL NUAt sR
4 10—
7
DAY
C LIN] FR SI M MASTER
OTHER MINDER
LOCATION O�F% GAS SVVALVE,
FUSE UM
360 QTY.
FUSE LM
430 QTY.
FUSE LINK
500 QTY.
oTr1FR
'
LDIRS
REPLACED
FUEL. SLiIJI-
OFF
GAS
'
Y7 NO
TESTED
�� NO
�
AEI �C
i
MANUAL PULL OPERABLE
DETECTION LANE
OPFRABIpJUNF7LAYED
ALL NOZZLES REMOVED CLEANED PER J CO
! MANUFACTURES SPECIFICATIONS
�//^^��
,� P NO
� r NO
F—�
YFB NO
lam%'
LOCATION OF SYSTEM
ANSUL SEAL. CART.
/ _7C.• / / , .!� /i � .�
YES NO
HOOD !
SIB
DUCT
SIM
MANAGER,'S
NAME /
PHONE
NUMBER
COOKING APPLIANCES LOCATION: LEFT TO RIGHT WITH SIZES
1�
2
3
4
5
6
7
8
?SPORT EACH SYSTEM WITH 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 96,1 7 &17A codes.
❑ Additional fire detectors are required to assure reliable fire
detection.
❑ This system is designed for coverage with no more than a fight grease
buildup. Grease 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
fail and should be replaced with a new system. Initials
❑ ON THIS DATE CUSTOMER WISHES NOT TO HAVE THIS
SYSTEM SERVICED.
Comments:
On this date the above system was inspected in accordance with the
State Fire Marshal regulations, the manufacturer's manual, and
Jorgensen Co. service manual.
SERVICE TECHNICIAN
Are all external hood penetrations sealed, welded or sealed
with a UL device? YES'` NO
Is pressure gauge in operable range? �L�-YES - -NO-
3. Record 6 year maintenance due date.
4. Record Hydrostatic due date.
5. Record 12 Year regulator test due date.
6. Are cartridge's weights within acceptable limits? YES,-NO
7. Is the proper extinguisher in place and serviced? ENO
8. Are the exhaust fans working? l YES,-.NO
9. Next due date for extinguisher service..)
10. Next due date for extinguisher hydro. (� ✓ ✓/
c.-
11. Is this system a U.L. 300? MONO
❑ With the introduction of Vegetable oil in place of animal fat, U.L.
has changed it's standard to extinguish grease fires. We understand you
are using this type of oil. We recommend upgrading to the new standard
to assure you have the proper fire protection Initials
I have been instructed on and understand the operation of this system.
CUSTOMER'S AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated m this report.
WHITE - CUSTOMER COPY CANARY - JORGENSEN PINK - AUTHORITY HAVING JURISDICITON