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<br /> . � License# �� � �� SYSTEM INSPECTION FORM
<br /> (352)72&1440 Tel. Class A#FEDi i-000016 Dat County/ i^'A.H.J){` U�300, wet Dry
<br /> (352)728-8332 Fax Class D#75004900022006 -���4� I k za�A t l�,I 15 ves'I� No❑ u
<br /> A �I IVE Annual Semi-Mnual� Rech. Installation Renovation Manufacturer
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<br /> FirE � Saf�ty, �NC. Location of Syst ms Cylinders M/oydel Number
<br /> SALES AND SERVICE �� ���e �`�v� ` � ���
<br /> Gylinder Size Maste Cylinder Size Slave Cylinder Size Slave
<br /> 2001 SOUTH STREET,LEESBURG,FLORIDA 34748
<br /> Serial Number Serial Number '.�Serial Number ��
<br /> Name �e��`�P"�r��_� ��e<< 1 � 2.7 7C�S � �
<br /> � -. Fuse Links 360° FUSE Links ^� '�- °F Thermostat -�F1~
<br /> Address � J�� ��'�' � �'
<br /> I D Number: Date: � � Number: ,plumb�
<br /> City ���`�r��1►S � r- �J�� /
<br /> Hood#1 Size: Hood#2 Size:
<br /> Telephone( ) Duct#�size: � Duct#1 Size: _--�'`�/
<br /> OwneY or Manager ouct#2 s�ze:�f/ ouct a2 'z�
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<br /> Store Number Last 6 Year Date Last Hydro Test Date Last Recharge Dat
<br /> Related Invoice � �
<br /> Manufacturer's Manual Reference
<br /> 1. Check haiard against original layout,note any changes � Page Number: Drawing Number:
<br /> 2. Pressure gauge indicator in operable range for stored , /
<br /> pressure cylinders � Cartridge: Inspected❑ Replaced❑ s ��A
<br /> /' Weight: Pressure: Last Test: ����1 �
<br /> 3. There are no visible signs that system has been fired or �
<br /> been tampered with Y Fuel Shut Off �
<br /> 4. Check ail piping an conduit Must be immobilized with � Electric: Shunt-Trip❑ Gas:Mech❑ eiectric,�f size:�`��S� ��"� `�
<br /> proper hangel5 and bwdckets Electrical s unt-rrip Location:
<br /> 5. All hood penetrations are welded or have grease tight `, � P � S`�vP Fe-�s� SG�`C(',�
<br /> fittings ' �V Fire Alarm Panel Location:
<br /> 6. Check positioning of all noules � y�� ��^� �� � �����P
<br /> 7. All noules are of proper iype y
<br /> 8. Replace all protective covers on nozzles or nozzle seals � 27. ReseUcock control head �
<br /> 9. Clean Nozzles � 28. Fan warning sign on hood ,YesC�-N�'C'�'
<br /> 10. Check cable nut travel tolerances � 29. Cartridge(s)installed Yes-�NaC�
<br /> 11. Test system operation from terminal link for proper operation 30. If all cooking surFaces not protected give customer �
<br /> 12. Test system operation with manual and remote manual for / full information
<br /> proper operation �� 31. Proper separation between fryers 8�flame Ye�-No�'
<br /> ' 13. Test operation of gas valves � � 32 Inspection safety pinsAock bars are removed Yes�� No❑
<br /> 14. Test operation of micro switch(s) 33. Inspection and senrice tag on system cylinder
<br /> 15. Clean excess grease from conduit at comer pulleys . /' and remote pull station Yes� No❑
<br /> and components y � 34. Personnel has been instructed on operation of ,
<br /> 16. Replace fusible links(every 6 months) `/ system(s)and portable(s) Yes� No❑
<br /> 17. Fitters are of proper type Yes�No❑ 35. Are hand portable extinguisher(s)property
<br /> . 18. Filters are clear of grease Yes'[�j No❑ serviced Yes�l No❑
<br /> ' 19. Hood and duct are clean of grease � Yes p No_❑ 3g, portable extinguisher iyrpe 40 BC❑ K type�[�✓
<br /> 20. All filters are replaced in hood Yes�I No❑ 37. Portable extinguisher(s)have proper rating Yes d No❑
<br /> 21. Exhaust fan(s)are in operating condition Yes�No❑ 38. Is fire alarm connected to the fire suppression �,
<br /> 22. Replace and seal all safery pins in manual and _ / system? Yes� Mo❑
<br /> remote releases � 39. Is fire alarm reset Yesr No❑
<br /> 23. Replace system covers 40. Pictures taken Yes� No�
<br /> 24. Fuel shut-off is in on position YesC�-Plo�� 41. Drawings attached Yes b No❑
<br /> 25. Customer lit pilot lights Yes{�-N�0'°' 42. Maintenance performed per MFG Manual Yes,�7 No❑
<br /> 26. Clean system cylinder �r 43. Maintenance performed per presently,adopted NFPAs , Yes� No�l
<br /> COMMENTS: 44. Indicate standards used:NFPA 17 ,an 4� NFPA 17A � NFPA 96 �
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<br /> Appliances and Sizes(Left to Right)
<br /> An A-Line Fre and Safety,Inc.authorized technician has completed your life safety inspection per local code,NFPA guidelines and manuFactures requiremenis.Safe operation of your equipment is the responsibilii�l of the facility
<br /> owner or tt�eir agent You are responsible for ensuring that any correotions and repairs to your I'rfe safety systems are completed.A-Line Fre and Safeiy,Inc.will provide a formal quotation to complete the required repair to_bring
<br /> your life safety systems back into compliance.A-Line Fire and Safety,Inc.does not assume any liability for the condition of your I'rfe safety systems and is acting as an advisor on the warking condition,performance potential and
<br /> code compliaq e of your I'rfe safeiy systems.According to Florida State Shatue 633.071,a copy of the inspection report noting any deficiencies shall be forwarded tn the local authority within 3A days`ofU)e date o service.�lJriless yo
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<br /> specificall�la or�eA-Line Fr and Saf ,Inc.to pertorm the necessary repairs,any deficiencies,impairments or required repairs discovered as a resutt of our inspections are not�tti,e responsibildy�of.A-�n�F�and Sa�,Inc�
<br /> Tec S an i n t A� i ss Si na re �Customer Si�ure
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<br /> Permit No. Da e Time In Ti e Odt Signature Printed
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<br /> The above named technician wrho holds a State of Florida permit certifies that they personally inspected ttie system and found the conditions
<br /> to be as indicated on this report.A-Line Fire&Safeiy,Inc.
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