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Pre-Engineered Restaurant Fire Suppression Systems Report <br /> SERVICE COMPANY DATE OF SERVICE TIME � A.M. P.M. <br /> ANNUAIB : SEMI-ANNUAL I RECHARGE INSTALLATION RENOVATION <br /> STATE FIRE PROTECTION INC , <br /> 17 4 4 12 T H S T R E E T S E N°3 LOCATION OF SYSTEM CYLINDERS UL 300 <br /> LARGO FL 33771 ves NO <br /> 7 2 7 - 7 9 7 -2 H 6 4 MANUFACTURER MODEL NUMBER WET DRY CHEMICAL <br /> S T A T F L IC . 02823400a31987 r; /X/1 '` - <br /> SjAjE L IC , 02823400Q � 198 ] fey;V"' r ✓ r <br /> CYLINDDE/R'SIZpE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE <br /> 4-. f t <br /> CUSTOMER FUSE LINKS 360°F. FUSE LINKS 450°F. FUSE LINKS 500'F. OTHER <br /> Name f'.�°'r°/;�i?,',��i" r . ���r__'r' " <br /> FUEL SHUT-OFF ELECTRIC GAS SIZE <br /> Ad dress <br /> SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE <br /> City Stater ZIP.s "- y <br /> MANUFACTURER'S MANUAL REFERENCE <br /> 1 <br /> Telephone Store No. ,7t 4-7 <br /> PAGE NUMBER: DRAWING NUMBER.><,,jt' DATE .V f i f i <br /> Owner or Manager A <br /> COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT <br /> Y 1 `' L2 4 {�(1" ,kn �` 1 1 ,,,•ta c' <br /> ?'.v �`{.✓lt�.ti��--Y 4 �! <br /> 1. All appliances properly covered w/correct nozzles 20. Replaced fuse links &?' � <br /> 2. Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/S-hooks <br /> 3. Check positioning of all nozzles. ~•4- 22. Piping&conduit securely bracketed <br /> 4. System installed in accordance w/MFG UL listing 23. Proper separation between fryers&flame <br /> 5. Hood/duct penetrations sealed w/weld or UL device "r 24. Proper clearance-flame to filters eAF <br /> 6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order <br /> 7. If system has been discharged, report same 26. All filters in place ° <br /> 8. Pressure gauge in proper range(If gauged) 27. Fuel shut-off in on position ' <br /> 9. Check cartridge weight(If applicable) 28. Manual&remote set/seals in place <br /> 10. Hydrostatic test date ' 29. Replace systems covers <br /> 11. 6 year maintenance date 30. System operational&seals in place <br /> 12. Inspect cylinder and mount f 31. Slave system operational �r <br /> 13. Operate system from terminal link !fit 32. Clean cylinder&mount <br /> 14. Test for proper operation from remote 33. Fan warning sign on hood <br /> 15. Check operation of micro switch 34. Personnel instructed in manual operation of system : <br /> 16. Check operation of gas valve 35. Proper hand portable extinguishers <br /> 17. Clean nozzles `-` 36. Portable extinguishers properly serviced x <br /> 18. Proper nozzle covers in place 37. Service&Certification tag on system <br /> 19. Check fuse links and clean AIA NOTE DISCREPANICES OR DEFICIENCIES BELOW A ,(,r� <br /> COMMENTS- _ <br /> On this date,-this pre-engineered fire suppression system was inspected and operationally tested in accordance with the fire <br /> suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results indicated above. <br /> X ;� iY'r,9'?y:���C f��/G`r•,���.i�/'`7�;r /?il'�� %�•.1��� ;`� <br /> SERVICE TECHNICIAN PERMIT NO. DATE: TIME: - AM PM CUSTOMER'S AUTHORIZED AGENT <br /> The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. <br /> AUTHORITY HAVING JUMSDICTION <br />