HomeMy WebLinkAbout2005-05-09 Kitchen Hood Fire System Inspection Report Kitchen Hood Fire %stem Inspection & laintenance Report
DATE OF SERVICE TIME A.M. P.M.
ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION
`96....-3` LOCATION OF SYSTEM CYLINDERS
Northland i
Fire & Security MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
Your Life Safety Specialists CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
4445 W.77th St.,Suite 125, Minneapolis,MN 55435 (952)893.0905
FUSE LINKS 360°F FUSE LINKS 450°F FUSE LINKS 500°F OTHER
Name le C e l i ?d /CM 3
p� FUEL SHUT- FF A,1 ELECTRIC GAS ` SIZE
Address /45-paI �` -} I \( C.f.,. , t
(L.�t
7) SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
City �'� !� 1`t' r !'TSS i kt
, MANUFACTURER'S MANUFACTURER'S MANUAL REFERENCE
Telephone dei`-.7`E zS S Store No.
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NOTE:NON COMPLIANT SYSTEMS MAY FAIL TO EXTINGUISH/SUPPRESS A FIRE.
-
Owner or Manager • j ,
COOKING APPLIANCE LOCATIONS&SIZES:LEFT TO RIGHT
YES NO N/A YES NO N/A
1. System interlocked with building fire alarm 0 0 0 20. Check travel of cable nuts/S-hooks 0 Q 0
2. Duct and plenum covered with correct nozzles 0 0 0 21. Piping&conduit securely bracketed 0 0 0
3. Check positioning of all nozzles 0 0 0 22. Proper separation between fryers&flame 0 0 0
4. System installed per U.L. 300 standard&meets 23. Proper clearance-flame to filters 0 0 0
manufacturers U.L. listing&N.F.P.A standards 0 0 0 24. Exhaust fan in operating order 0 0 0
5. Hood/duct penetrations sealed with weld or UL device 0 0 0 25. All filters replaced 0 0 0
6. Check if seals intact, evidence of tampering 0 0 0 26. Fuel shut-off in on position 0 0 0
7. If system has been discharged, report same 0 0 0 27. Manual&remote set/seals in place p 0 0
8. Pressure gauge in proper range(if gauged) 0 0 Q 28. Replace systems covers 0 0 0
9. Check cartridge weight(if applicable) 0 0 0 29. System operational&seals in place 0 0 0
10. Dry system 6 year maintenance date/wet system 12 30. Slave system operational 0 0 0
year hydro-test date 0 0 0 31. Clean cylinder&mount 0 0 0
11. Inspect cylinder and mount 0 0 0 32. Fan warning sign on hood 0 0 0
12. Operate system from terminal link 0 0 0 33. Proper signage and personnel instructed in manual
13. Test for proper operation from remote 0 0 0 operation of system 0 0 0
14. Check operation of micro switch 0 0 0 34. Proper hand portable extinguishers 0 0 0
15. Check operation of gas valve 0 0 0 35. K class fire extinguisher in cooking area 0 0 0
16. Clean nozzles 71 0 0 36. Portable extinguishers properly serviced 0 0 0
17. Proper nozzle covers in place 0 0 0 37. Service&Certification tag on system 0 0 0
18. Check fuse links and clean 0 0 0 38. Safety chains on all gas appliances attached and secured l 0 0
19. Replaced fuse links Cl 0 0 NOTE DISCREPANCIES OR DEFICINCIES BELOW 71 0 0
COMMENTS:
On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of
NFPA 17, 17A, 96 and the manufacturer's manual and was operated according to these procedures with results indicated above.
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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.
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