HomeMy WebLinkAbout2004-11-23 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
�.3 LOCATION OF SYSTEM CYLINDERS I( t
Northland Z '
Fi►'�e & Secure MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
-- --LYbU/tT�C-'SB Clalists CYLINDER SIZE MA�)TER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
4445, 77th St.,Slate 125,Minneapolis,MN 55435 952)893.090@ _ G(4 /
- FUSE LINKS 380°F FUSE LINKS 450°F FUSE LINKS 500°F OTHER
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Nam- ( C t C F r ..
FUEL SHUT-OFF ELECTRIC GAS SIZE
A••ress /4- 7 CL�K '1- A (PIs /4r-GrC tAe( 4
SERIAL NUMBER LAST HYDROJTEST DATE LAST RECHARGE DATE
City %(L' . �Mi -- 9`T __
, ..J_,A 3 MANUFACTURER'S MANUAL REFERENCE ,
Telephone -1 4--ZG, -2� Store No.
�.. NOTE:NON COMPLIANT SYSTEMS MAY FAIL TO EXTINGUISH/SUPPRESS A FIRE.
Owner or Manager 671,'�' L.,rt 11. j,r f M
COOKING APPLIANCE LOCATIONS&SIZES:LEFT TO RIGHT
"")1e r,
r+ 6 frr/u(
YES NC Nle YES NC Nae
1.System interlocked with building fire alarm O O ® 20.Check travel of cable nuts/S-hooks 0 O O
2.Duct and plenum covered with correct nozzles RI O O 21.Piping&conduit securely bracketed RIO O
3.Check positioning of all nozzles 0 O O 22. Proper separation between fryers&flame 0 O O
4.System installed per U.L.300 standard&meets 23. Proper clearance-flame to filters 0 O O
manufacturers U.L.listing&N.F.P.A standards ill O CI 24. Exhaust fan in operating order 0 CI O
5.Hood/duct penetrations sealed with weld or UL device 0 O O 25.All fitters replaced O O
6.Check if seals intact,evidence of tampering CI O ® 26. Fuel shut-off in on position 0 O O
7.If system has been discharged,report same O El 9 27. Manual&remote set/seals in place M O O
8.Pressure gauge in proper range(if gauged) O O a 28. Replace systems covers M O O
9.Check cartridge weight(if applicable) E! Cl O 29.System operational&seals in place 0 O O
10.Dry system 6 year maintenance date/wet system 12 30.Slave system operational O O GFI
year hydro-test date 0 O O 31.Clean cylinder&mount M O O
11.Inspect cylinder and mount H O O 32.Fan warning sign on hood an O O
12.Operate system from terminal link PJ O O 33.Proper signage and personnel instructed in manual
13.Test for proper operation from remote 0 O CI operation of system M O O
14.Check operation of micro switch 0 O O 34.Proper hand portable extinguishers 0 O O
15.Check operation of gas valve 0 O CI 35.K class fire extinguisher in cooking area M O O
16.Clean nozzles 31 O O 36.Portable extinguishers properly serviced M O O
17. Proper nozzle covers in place 9 O O 37.Service&Certification tag on system ¢1.,O 17
18.Check fuse links and clean 0 O O 38.Safety chains on all gas appliances attached and secured ?7 1 O
19.Replaced fuse links O O 61 NOTE DISCREPANCIES OR DEFICINCIES BELOW O O CI
COMMENTS:
On this date,the above system was tested and inspected in accordance with procedures of the presently adopted editions of
NFPA 17,17A, and the manufact rer's manual and was operated according to these procedures with results indicated above.
x = fitth-. /lam9-C4- //.4c
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