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Kitchen Ifbod Fire System Inspection & Maintenance Report
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Northland -.~
Fire.'
Your Life Safety Specialists
4445 w. 77th St" Suite 125. Minneapolis. MN 55435 (952) 893.0905
ANNUAL
INSTALl.ATION
P.M.
WET DRY CHEMICAL
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CYUNDER SIZE MASTER
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CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
FUSE LINKS 4500 F FUSE LINKS 5000 F OTHER
SERIAL NUMBER
...3
mR;L
LAST HYDRO TEST DATE
7
SIZE
Name 0 'Met //.('1 ~
Address/c"Z /I /"1c ''''' ,dV<!- '5E
City 'Pr JOY- Lo. lit', fV1 N - "')") 17-Z.
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TelePhone(7"b1 )-9'+'0' f3(aY) Store No.
Owner or Manager ~ \!:.~ A("m i~
CieXiKING APPUANCE LOCA ONS & SIZES: LEFT TO RIGHT
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FUEL SHUT-OFF
LAST RECHARGE DATE
MANUFACTURER'S MANUAL REFERENCE
NOTI!: NON COMPL
REC MMENDEDTHATY REPLACENPGRA YOUR
WET HEMICAL SYSTEM D IIINlMAL UASlL IN THE
1. System interlocked with bUilding. fire aIann. ~~. 20. Check travel of cable nuts! S-hooks ~ ~ Ji}'
2. Duct and plenum covered with correct no~es ~ 21. Piping & condu~ securely bracketed J!f LJ LJ
"3.CIieCK j5ffilftiOOlfigOfa1tnozzRlS'--' ,c~c'-_o'-""'-2(uLf '22.t'fijpef~lfyefS~--""~'-:B""LrU-
4. System installed per U.L 300 standard & meets 23. Proper clearance-flame to fitters g LJ LJ
manufacturers U.L listing & N.F.PA standards LJ ;5 LJ 24. Exhaust fan in operating order jlJ LJ LJ
5. Hood/duct penetrations sealed wtth weld or UL device ~ LJ LJ 25. All fitters replaced ~ LJ LJ
6. Check ~ seals intact. evidence of tampering jlJ CJ CJ 26. Fuel shut-off in on position ~ CJ CJ
7. If system has been discharged, report same LJ ;!1 LJ 27. Manual & remote set/seaIs in place j( LJ LJ
8. Pressure gauge in proper range (If gauged) LJ LJ;K 28. Replace systems covers 13 LJ LJ
9. Check cartridge weight (If applicable) ~ LJ LJ 29. System operational & seals in place 7/ LJ g,
10. Dry system 6 year maintenance date! wet system 12 30. Slave system operational CJ LJ ZJ
year hydro-test date Jlf CJ CJ 31. Clean cylinder & mount ~ CJ CJ
11. Inspect cylinder and mount fi! LI LJ 32. Fan warning sign on hood J8 CJ CJ
12. Operate system from tenninallink 9J LJ LJ 33. Proper signage and personnel instructed in manual
13. Test fori proper operation from remote 2J LJ LJ operation of system 2J LJ LJ
14. Check operation of micro switch LJ LJ ~ 34. Proper hand portable extinguishers jlJ LJ LJ
15. Check operation of gas valve P: CJ CJ 35. K class fire extinguisher in cooking area CJ ;J CJ
16. Clean nozzles If. LJ LJ 36. Portable extinguishers propel1y SBlViced ;!f LJ LJ
17. Proper nozzle covers in place 2' LI CJ 37. Service & Certification lag on system j!J LI CJ
18. Check fuse links and clean ~ LJ LJ 38. Safety chains on all gas appliances attached and secured LJ LJ ~
19. Replaced fuse links /11 LJ LJ . / NOTE DISCREPANCIES OR EFICINCIES BELOW LJ LJ LJ
CO MENTS: :tI. 3 C. IQ It!! /) n I r
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ystem was tested and inspected in accordance with procedures of the presently adopted editions of
manufacturer's manual and was operated according to these procedures with results indicated above.
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SERV TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMERS AUTHORIZED AGENT
The above S81Vice technician certifies that the system was personally inspected and found condttions to be as indicated on this report.
WHITE - CUSTOMER
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YELLOW - DISTRIBUTOR
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PINK - AUTHORITY HAVING JURISDICTION