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Range Ho�o' "' .., ty.5,tems Deport <br /> DATE.OFSERVICE TIME A.M. P.M. <br /> q44 <br /> V <br /> ANC <br /> E® ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION <br /> LOCATION OF SYSTEM CYLINDERS <br /> 14 S. Laurel Ave. MANUFACTURER A f 7DELNUMBER WET 7HEMICAL <br /> r? <br /> Samford, FL 32771 4 r`s1,� .,�, r= <br /> (407) V 99-V 990 CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE <br /> FUSE LINKS 360°F FUSE LINKS 450'F FUSE LINKS 500°F OTHER <br /> t CUSTOMER �G <br /> Name �"��a'snf"�.6'�; �'A��� <br /> 'L` � =� FUEL SHUT-OFF ELECTRIC GAS SIZE <br /> Address U�: 1, , <br /> SERIAL NUMBER 7STHYDRO TEST DATE LAST RECHARGE DATE <br /> City yy {i•f e. ;da d � _..l_- - #� �_, ry_ 0 <br /> MANUFACTURER'SMANUALREFERENCEJ,� <br /> Telephone Store No. <br /> t-4- <br /> PAGE NUMBER; I � DRAWING NUMBER:e,?€_1 <br /> Owner or Manager <br /> COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT gg <br /> 1.All appliances properly covered w/correct nozzles a 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. 22. Piping &conduit securely bracketed <br /> 4. System installed in accordance w/MFG UL listing 23. Proper separation between fryers&flame, F <br /> 5. Hood/duct penetrations sealed w/weld or UL device 24. Proper clearance-flame to filters <br /> 6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order <br /> 7. If system has been discharged, report same C 26.All filters replaced <br /> 8. Pressure gauge in proper range (If gauged) _7 >'=`�"�� 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 g 29. Replace systems covers <br /> 11. 6 year maintenance date j 30. System operational &seals in place <br /> 12. Inspect cylinder and mount 31. Slave system operational <br /> 13. Operate system from terminal link 32. Clean cylinder& mounter <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 <br /> 18. Proper nozzle covers in place 37. Service &Certification tag on system <br /> 19. Check fuse links and clean NOTE DISCREPANCIES OR DEFICIENCIES BELOW <br /> COMMENTS: r`.",I G Ott <br /> q <br /> fl�`����• .�..rq r �f..�P�.d�`��i�• "�� G'I.r� r�^-6 J§ ..:`�^8�'� `` rs".?k�-i �`dZ:�IJ`r''�'�i�':� �fJ�i'-�+'� 1"E''`_ �.1�^.�`a C�`5��-'{`llL'• I �f � <br /> On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of <br /> NFPA 117, 17A, 96 and the manufacturer's manual and was operated according to these procedures with results indicated above. <br /> SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMEkS 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 /> WHITE-CUSTOMER COPY YELLOW-DISTRIBUTOR <br />