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Kitchen Hood Fire 5Jstem Inspection & Maintenance Report
I A"M" I P.M.-
I RENOVATION
Northland --.
Fire & SecuritiJ
Your Life Safety Specialists
4445 w. nth St., Suite 125. Minneapolis, MN 55435 (952) 893.0905
Name~O'NU\ nC l,",c Le,k'
Lt.....~'\U'(l)Y'(~\~'l{~
Address '-37 f..:L) M/ 1<'", Y1 \"\ .:A
10':(\ N.I,...)
Clt1f JllJ, \0( l.ll,
MrJ
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Telephone (i/"'i.2)23:=>- x'lt:b
Store No.
Owner or Manager j"" ),..., /k. f"'\
COOKING APPOANCE LOCATIONS & SIZES: LEFT TO RIGHT
YES 00 !!ILA
0"00
.0"00
~L1tJ
1. System interlocked w~h building fire a1ann
2. ~. ao.d p!El!lum cov..ered ~hcorrect nozzles
3. Check positioning of ail noziles- >""- - ,-
4. System installed per U.L. 300 standard & meets
manufacturers U.L. listing & N.F.PA standards J? 0 0
5. Hood/duct pane;, "'~;v,,~ sealed w~h weld or UL device 13 0 0
6. Check ~ seals intact, evidence of tampering 9J 0 0
7. ~ system has been discharged, report same 0 ;K 0
8. Pressure gauge in proper range (If gauged) 0 0 1!f
9. Check cartridge weight (If applicable) Qr 0 0
10. Dry system 6 year maintenance date! wet system 12
year hydro-test date
11. Inspect cylinder and mount
12. Operate system from terminal link
13. Test for, proper operation from remote
14. Check operation of micro sw~ch
15. Check operation of gas valve
16. Clean nozzles
17. Proper nozzle covers in place
18. Check fuse links and clean
19. Replaced fuse links
COMMENTS:
~OO
J3'00
BOO
.000
J3"00
]21"00
~OO
.000
2100
.2Joo
DATE OF SERVICE l TIMt;
).//77f-'\
ANNUAL .. l g'E'XNNUAL J AECHARGE I
LOCATION OF SYSTEM CYLINDERS
INSTALLATION
f"n uf I-Lex!
MANUFACTURER I MODEL NUMBER WET I DRY CHEMICAL
/1Y1~\ 12 fcZ. 1(
C:~;;: ~'~: :TER I CYLINDER SIZE SLAVE J CYLINDER SIZE SLAVE
'UM!L1NKS/60' , 'USE LINKS 450' , I 'USE 3S 500" I OTHER
FUEL SHUT.QFF ELECTRIC 1 GAS size
Vb ~C~ ntrcl
. SERIAL NUMBER LAST HYDRO TEST DATE
LAST RECHARGE DATE
03
MANUFACTURER'S MANUAL REFERENCE
NOTE: NON COMPLIANT SYSTEMS MAY FAIL TO EXTINGUISH! SUPPRII. A FIRE.
YES 00 !!ILA
20. Check travel of cable nuts! S-hooks 0 0 ;!f
21. Piping & condu~ securely bracketed ;:r 0 0
22: l'ropersepal'atlon betVlel!rrfryers~'--'-" --.. -t'H3-f'f
23. Proper clearance-fIame to fitters ...a 0 0
24. Exhaust fan in operating order ~ 0 0
25. All fitters replaced .a 0 0
26. Fuel shut-off in on pos~lon .Zf 0 0
27. Manual & remote setlseals in place ~ 0 0
28. Replace systems covers ;'l 0 0
29. System operational & seals in place Rf 0 0
30. Slave system operational 0 0)2l
31. Clean cylinder & mount % 0 0
32. Fan warning sign on hood jiJ 0 0
33. Proper signage and personnel instructed in manual
o,..o,,,,~;v,, Of system 21 0 0
34. Proper hand portable extinguishers 21 0 0
35. K class fire extinguisher in cooking area . J:!'.O
36. Portable extinguishers properly serviced ~ 0 0
37. Service & Certification tag on system ;:r 0 0
38. Safety chains on all gas appliances attached and secured 0 0 flJ'
NOTE DISCREPANCIES OR DEFICINCIES BELOW 0 0 0
On this date. th~e system was tested and inspected in accordance with procedures of the presently adopted editions of
NFPA 17.)f A(Bf? ancl\the manufacturer's manual and was operated according to these procedures with resutts indicated above.
x~~ /0, I I I I Ix/~/ / <y
" SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMERS AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
WHITE - CUSTOMER
.
YELLOW - DISTRIBUTOR
.
PINK. AUTHORITY HAVING JURISDICTION