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iikiiii6iiii4 VQkii 1109 Ponce De Leon Blvd. <br /> Brooksville, FL 34601 <br /> AND SAFETY EQUIPMENT CO., INC. (352) 796 - 4433 <br /> SYSTEM SERVICE REPORT: NEW ❑ ANNUAL ❑ SEMI- VRECHARGE ❑ <br /> E • ` , agar / Owner & Phone Store No <br /> '/ s x Jr / a J <br /> q.. -ss ,410 .r rr AI <br /> r �� <br /> P' - _ _ , oc � , j �+ . err f �- ' fg. i Alf f! . A <br /> L. - -I Authority to be filed with Fu= r ' ■ ❑ Elecir ic Shunt -Trip <br /> J <br /> 1 *Contactor Gas: r, ec . ❑ Elect. <br /> System Diagram <br /> Initials <br /> Customer received the informational letter addressing NFPA -96 and operational instructions = ' Y-...---"-2 <br /> Customer given the UL -300 letter if applicable <br /> . ...- l <br /> 1. Appliances correctly protected ke"....- 20. Test from terminal link • <br /> 2. Correct duct/plenum nozzles 1.- 21. Test operation from remote pull L" -- <br /> 3. Check position of all nozzles L.--- 22. Test operation of micro switch <br /> ./0 r <br /> 4. Correct pipe,size /limitations /...- 2 Test operation of gas valve <br /> 5. Penetrations sealed, GT N'' 4. Proper nozzle covers /caps 1� <br /> 6. Pipe & conduit secure 25. Clean nozzles <br /> 7. Separation fryers to flame 16" 2 All filters replaced _____1 ,,,r <br /> 8. Separation -flame to filters L . •. 27 Fuel shut-oft in on position ", ^^ <br /> 9. Inspect cylinder and mount j.. 28. Replace system cover(s) L--- <br /> 10. Clean cylinder and mount "- 29. Exhaust fan operational 1------ <br /> 11. Evidence of tampering V 30. Manual and remote set f-- <br /> 12. Has system been discharged 31. Tamper seals installed <br /> 13. Clear piping �""' 32. Slave system operational <br /> 4 Pressure gauge within range w >< 33. System operational <br /> 5. Cartridge weight: «�li. 34. Personnel briefed on system y'" <br /> 16. Hydrostatic test due date .,,/�'` 35. Proper portable extinguishers <br /> 17. Six -year maintenance due date 2 36. Extinguishers serviced <br /> 18. Check fusible links /• --'''" 37. Fan warning sign on hood 022 <br /> 19. Replace below links dated: 38. Installed per 4A21.303 <br /> 1 39. Safety pin inserted /removed /mfg. Specs. - <br /> 165 280 360 450 ,, 500 40. Meets manufacturer's specifications ,� <br /> ,� . , J / . C ■ mnlies w " .33 01 ; .-^ <br /> ,...• •mu�en . /U• c -.- ci -s: __. /�" �,,'' J' 1 <br /> Atf24" .,�7!'' Iw 0 2 I VA . /�� . /Il lAiNfiter.�r! AZeff,�'�r fii . <br /> , ` J�' J lJ''l/ WarAlli r.;G ? dr ral/FPi i!r �/. i <br /> J <br /> Pyro Chem Ansul Amerex Kidde Range Guard Safety First FSI <br /> 1. pin removed 1, link lever set 1. pin removed 1. pin removed 1. reconnect head 1. reconnect union 1. pin removed <br /> 2 cartridge inserted 2. cartridge replaced 2. cartridge replaced 2. cover replaced 2. pin removed 2. link lever cocked 2. cover replaced <br /> 3 copper tube tightened 3. cover installed 3. cover installed 3. Peer tube tightened 3. pins removed 3. m- switch reset <br /> I$I,4 '94 Pt/ /j, L__ <br /> Technician Permit Number Da a ' ' Time customer'S�7Aufliorized Agent 1' <br /> Copies To: Customer, Distributor, Fire Marshall, if applicable. ., ' .----` <br />