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For Information Regarding this Report PRE-ENGINEERED <br /> • Please Call SYSTEM INSPECTION REPORT <br /> - 800-522-7150 <br /> Fir�eRMaster` <br /> SRO# 3 Date �j ` 2 � ^� <br /> ❑QUART RLY ❑ANNUAL ❑SEMI-ANNUAL ❑ NEW INSTALLATION ❑ FIRST INSPECTION ❑ CHANGES MADE <br /> Customer G � C rCU Customer# . <br /> Address � � �f � k ' T 1 ��,� J J Z <br /> Manager/Owner P one �� y ' � - <br /> System Location . � _ �� Manufacturer � G�2�y Model ' � � #Cylinders � - . <br /> Cylinder size(s) /�� <br /> List main cylinder size tirst 1� Method of Actuation Number Degree <br /> Last Hydro Q� Last Recharge � Serial Number �j � Fuel Type <br /> Restaurant Marine❑ Industrial ❑ Inspected per Installation Elec❑ Gas❑ <br /> Manual Date Size <br /> � ��. <br /> l � ?� � � g� � t �� � <br /> . . _ . .. . . .. . <br /> � <br /> . ........... .. .. . <br /> �� ►� i <br /> , � � Y�-. . . .......... . .. ......... . <br /> ...... . . . <br /> . ............. <br /> �� .. ° z3 K 3 � �� 2 3 �{ 36 � z�f <br /> l I <br /> � � ( `� �, , <br /> 1 G � ��c��� <br /> � Q ��� C. YES NO N/A <br /> 1 Is system mounting bracket in ac ssible�cation and soundly mounted? � L ❑ � <br /> rblocka e? � � <br /> 2. Is piping tight,secured and checked fo, g <br /> 3. Are grease tights installed at all hood penetrations? � � <br /> 4 If multiple systems,did all systems operate satisfactory? � � � <br /> 5. Is system properly installed to properly protect hazard(s)? � <br /> 6. Are all nozzles properly located and proper type? � � <br /> 7 Is manual pull operational and in proper location? � � <br /> 8. Are all fusible links or HAD's of proper temperature rating? � � <br /> 9. Were fusible links replaced? � � <br /> 10. Is automatic detection operational? � � <br /> 11 Did fuel shut off properly? � � � <br /> 12. Did all e�ectnc shut down under hood(s)and alarms operate? � � � <br /> 13. Are bursting disc and chemical in good condition? .�` � � <br /> 14 Is cartridge within proper weight? �tl � � <br /> 15. Are all noules clean and caps/seals properly installed? � � � <br /> 16. Is cylinder pressure in operational range? � � � <br /> 17 Are filters clean and in good condition? � � <br /> 18. Was system placed back in service and in normal operation condition? ... � � � <br /> 19. Have persons working in area been instructed on proper operation of system? � � <br /> 20. Was the inspection/maintenance performed in accordance with NFPA 17,17A and 96? ❑ ❑ <br /> 21 Was inspection/maintenance performed in accordance with manufactures specifications? ❑ ❑ <br /> 22. Does system comply with UL300? � � <br /> 23. Was system tagged in accordance with 69A-21?(Florida only) � � <br /> Comments �, �` <br /> I,THE UNDERSIGNED,CERTIFY THAT I PERSONALLY INSPECTED TH OVE PREMISES AND FOUND CONDITIONS AS NOTED <br /> PermiVLicense�l <br /> Service echnic n Date Tim Customer Sign Date <br /> � � 3 � �,/ PM <br /> FL 1041 ( /12 Form X-PSI < i�`-!�'�'•'��'� ���F'� <br />