HomeMy WebLinkAboutKitchen Hood Report 12/20/2010 I�itchen Hood Fire System Inspection & Maintenance Report
DATE OF SERVIC �� TIME A._ M. ,, PM.
r') '];``y ��
L c �.�r
ANNUAL SEMI-AN AL RECHARGE INSTALLATION RENOVATION
NO rthland i LOCATION OF SYSTEM CYLINDER �
�(. �'�. +�1 r� � � F2 C.-^''C S-
Fi rre & S�ecuriiy MANUFACTURER MODEL NUMBER WET CHEJviICAL DRY CHEMICAL
Your Life Safety Specialists � � �` � \ � � A �
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
4445 W. 77th St., Suite 125, Minneapolis, MN 55435 (952) 893.0905 �� G(.� `
MANIFOLDED PIRANHA WATERFLOW PRESSURE
Name ��.�'` �"'� r� 1 �� � y� L.Z � YES ❑ NO
FUSE LINKS 360°F FUSE �INKS 450°F FUSE L{NKS 500°F OTHER
Address � �..� � �U � a � � �j t • ?_,..�"
�^ MECHANICAL GAS VA VE(S) & SIZE(S) ELECT. GAS VALVE(S) & SIZE(S) MANUAL RESET RELAY
c�t � ��� � !''1N � ��V ❑YES ❑NO
SERIAL NUMBER LAST HYDRO TEST DATE LA$T RECHARGE DATE
Telephone � S� -� y�i ''J3 � 2 Store No. (�
Owner or Manager � t^ C?GX.J V�C 1� ANUFACTURER'S MANUAL REFERENCE
NOTE; NON COMPLIANT SYSTEMS MAY FAIL TO EXTINGUISW SUPPRESS A FIRE.
COOKING APPLIANCE LOCATIONS & SIZES: LEFT TO RIGHT
'"� l��?
YES NO WA YES NO WA
1. System interlocked with building fire alarm ❑� � 20. Proper separation between fryers & flame �C] ❑
2. Duct and plenum covered with correct nozzles •e7 jJ O 21. Prop�r clearance-flame to filters .•PJ'"� ❑
3. Check positioning of all nozzles .�t�D � �.� st fan in operating order �'� ❑
4. System installed per U.L. 300 standard & meets �,� ������ ��,��(P��e�,j �placed �0�� ❑
manufacturers U.L. listin g & N,F.P.A. standards ��7`` f`�, p,�1 }' �Fiu�=off in on position .0'�� �
5. Hood/duct penetrations sealed with weld or U��`�"'� �'�1'�� �. ��12�� �mote seUseals in place .8�� ❑
6. Check if seals intact, evidence of t `Jrt 0 �.7'��1'� �, � � tem covers ,�� ❑
7. Pressure au e in ro er ran e l �� I ��� �"' t �' � � �'�" ional & seals in lace 0'O ❑
9 9 P P 9 h y�11NG1. .�,� ��,,� �� tl 6 1`�' . P
8. C h e c k c a rt r i d g e w e i g h t ( i f a p p l i c a b �, V a 4� 1'�•'- p l ,� T ���� 2���� o p e r a t i o n a l ❑❑ S"'
9. Dry system 6 year maintenance4� ��,, ;�- ,..a$,�� c ylinder & mount ,0'�� ❑
12 year hydro-test date p M�EN u`'" p"i""'
NS��. ' .3c7.�an''vuarning sign on hood ,0'L7 ❑
10. Inspect cylinder and mount QIE� p��,5��� S � �l " 31. Proper signage and personnel instructed in
11. Operate system from terminal link 5 ��,�:M1����.� p❑ manual operation of system C�'�7 ❑
12. Test for proper operation from remd� .�❑ ❑ 32. Proper hand portable extinguishers �'� O
13. Check operation of micro switch -� ❑❑ 33. K class fire extinguisher in cooking area Ja' O O
14. Check operation of gas vafve fi�� ❑ 34. Portable extinguishers properly serviced �O O
15. Glean nozzles -� ❑❑ 35. Service & Certifiication tag on system S"'C7 O
16. Proper nozzle covers in place ,Jc�� ❑ 36. Safety chains on al{ gas appliances attached and secured O❑�O
17. Replaced fuse links -PJ'� ❑❑ 37. Status of greas uddup in the hood and duct opening
18. Check travel of cable �❑❑ ❑ Clean L1ght � Medium ❑ Heavy ❑ Excessive
19. Piping & conduit securely bracketed �❑ ❑ � NOTE DISCREPANCIES OR DEFICIENCIES BELOW �
COMMENTS:
� 2 0: ��u..- �/L-�� S t �v� n�a c v✓�'t. +� ��
On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of
NFPA�, A, 96 a d the manufacturer's manual and was operated according to these procedU'e esults indicated above.
o �
1 � G �:' � � , '•-� 12 - C7 _ 1 ,
.,,
E IAN 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
I(itchen Hood Fire System Inspettion & Maintenance Report
DATE OF SERVICE TIME A M. P.M
� C,. � � l.) 1 l.)
ANNUAL SEM1-ANNUAL AECHARGE INSTALLATION RENOVATION
� LOCATION OF SYSTEM CYLIND RS
Northland = t ���,,. � ` ` --� �, �.�
F I� � UIMY��� MANUFACTURER MODEL MBER WET CHEMICAL DRY CHEMICAL
Your Life Safet S ecialists ���'�� ���� X
y P CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
4445 W. 77th St , Suite 125, Minneapolis, MN 55435 (952) 893.0905 ^'�� �! �.� �
C�
MANIFOLDED PIRANHA WATERFLOW PRESSURE
Name ��- G� T"+ � N� � � C..Z � YES �10
FUSE LINKS 360°F FUSE LINKS 450°F FUSE LINKS 500°F OTHER
Address �1�� l� `► (� C7 �`'�' `".-�' 1 �`JL",. ' �
MECHANICAL GAS VALVE(S) & SIZE(S) ELECI: GAS VALVE(S) & SIZE(S) MANUAL RESET REIAY
Clty ��- ��. l,. Y f�`. � (� N ���� Z l.. V V ❑ YES ❑ NO
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
Telephone �1� � ' � y � ' �� Z- Store No.
Owner or Manager ��� ���"'`v ~� „�� MANUFACTURER'S MANUAL REFERENCE
NOTE: NON COMPLIANT SYSTEMS MAY FAILTO El(TINGUISW SUPPRESS i4 FIRE.
COOKING APPLIANCE LOCATIONS & SIZES: LEFT TO RIGHT
. �
\ O�L.�... '
YES NO WA YES O WA
1. System interlocked with building fire alarm ❑❑� 20. Proper separation between fryers & flame �� 0
2. Duct and plenum covered with correct nozzles .� ❑❑ 21. Proper clearance-flame to filters ,0 O❑
3. Check positioning of all nozzles �❑❑ 22. Exhaust fan in operating order ,� � O
4. System installed per U.L. 300 standard & meets 23. All filters replaced �7 ��
manufacturers U.L. listing & N.F.P.A. standards X� ❑❑ 24. Fuel shut-off in on position .0�❑ ❑
5. Hood/duct penetrations sealed with weld or UL device �❑ � seUseals in place �f �❑
6. Check if sea{s intact, evidence of tam L SUrR�-� � ��t��stem covers �� �
�,� � i�� ���4'�-
7. Pressure gauge in proper range (if ga����T �).l. -'�9�' "� ,27 �i��RE�a�t�nal & seals in place �❑ ❑
�'� ��1� ri
8. Check cartridge weight (if applicablel,,,, �y Ex'�lhG4� [�' ,�• �"f�£n operational O❑ f�
.,..�, ���s� �,�,�-,t�' : .�. s.��� ,
9. Dry system 6 year maintenance da��� i'; �- „, 29. G rY6�r��k mount -0'� ❑
12 year hydro-test date q ���� M ��Q� .. t!�� I�sQ"�' �' �0 �Fa� ��i01��jn on hood J�' ❑ 0
10. Inspect cylinder and mount � .;F)'�'�3� �"' �'1"� �xc�(,�ry����nd personnel instructed in
11. Operate system from terminal link ��''�°°� ,' .man��l operation of system ,0'b ❑
12. Test for proper operation from remo{�ET CNE���� ��� �`�`"� 32. Proper hand portable extinguishers �❑ ❑
13. Check operation of micro switch .,�3' ❑❑ 33. K class fire extinguisher in cooking area �� ❑
14. Check operation of gas valve P(�❑ ❑ 34. Portable extinguishers properly serviced fa'❑ ❑
15. Clean nozzles .,P�❑ ❑ 35. Service & Certification tag on system ,0'�� O
16. Proper nozzle covers in place ,f7�'❑ ❑ 36. Safery chains on all gas appliances attached and secured ❑❑@"
17. Replaced fuse links �❑❑ 37. Status of grease buildup in t hood and duct opening
18. Check travel of cable ,Cd� ❑❑ ❑ Clean ❑ Light edium ❑ Heavy O Excessive
19. Piping & conduit securely bracketed �Y'❑ ❑ {Y NOTE DISCREPANCIES OR DEFICIENCIES BELOW �
COMMENTS:
On this date the above system was tested and inspected in accordance with procedures of the preser�tl adopted editions of
NFP , 17A, 96 nd the manufacturer's manual and was operated according to these rocedure re ults indicated above.
X _�._ �, .7 �,' 2.t� - r
SERVICE NICIAN PERMIT NO. DATE: . TIME: AM PM CUSTOMERS AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found con tions to be as indicated on this report.
WHITE - CUSTOMER • YELLOW - DISTRIBUTOR • PINK - AUTHORITY HAVING JURISDICTION