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NAL It ®tCG <br /> : BOFESSIO <br /> 4i a .Safet 510-359-3179A � ' <br /> * " Please Mail Payment to State License Cis 1011525 <br /> Insured &Bonded <br /> ATY P.O. Box 27086 a Oakland, CA 94602 <br /> N4 Jy <br /> F ^F <br /> m 1 4 <br /> � PHONE 1 <br /> CONTACT <br /> CELL <br /> ADDRESS. <br /> �t. •t EMAIL <br /> CITY, STATE, ZIP '� I+i:-1'i <br /> TAG 1 4� Iry.i TAG 2 i <br /> - E OF SYSTEh4 - v; - t NUAL UNOBSTRUCTED <br /> TYP _ <br /> YEAR MANUFACTURED <br /> r~ 1M1{ { TAMPER INDICATORS&SEALS INTACT <br /> DATE OF LAST HYDROSTATIC TEST. `1.�`: _ p MAINtENANCE TAGS&CERTIFICATE <br /> p YSTEM IS UL300 COMPLAIN t�-F <br /> CYLINDER liVE1GHTIYERR i <br /> CYLINDER PSI PRESSURE ` <br /> POWER SHUT OFF.'GAS ❑ELECTRIC <br /> GAS CARTRIDGE TYPEIDATE <br /> NOZZLES QUANTITY ( LINKS s' ('� ,f]COMPLAINT ❑NON-COMPLAINT <br /> ❑YES,.❑NO QUANTITY <br /> CORRECT PLACEMENT(HEIGHT/AIM) -- <br /> APPLIANCES NUMBERED LEFT TO RIGHT 7NEW-PA <br /> ��FRYEWS. lD GRILLIS ❑WOK . <br /> " ~` <br /> I ;BROILERIS t ❑�RIDDLEIS �,[ARANGE.TOPIS LINKS <br /> ❑ <br /> POTlS <br /> El SALAMANDER ABC <br /> s' f <br /> ❑ ❑TANDOORI (fGYROS <br /> SPRAY BOOTH <br /> f. k KGIASSNZZLES r� <br /> CAPS CARTRIDGES <br /> j ID <br /> TYPE <br /> TYPE i <br /> tg ' <br /> - Ell d 0 IT] Fi <br /> COMMENTS m , <br /> Yes ❑Noesl- <br /> s <br /> understand that it is a requirement of the Califnrnfa_Code of <br /> 1 Regulations Title 19 that is the fire suppression system be`maintained <br /> semi-annually to ensure continued reliability and that failure to do r <br /> so may�result in failure of the system to operate property. <br /> Yes O No. n - <br /> I have received a copy of this maintenance invoice&understand the <br /> i payment terms:Payment due upon receipt.Mail-in terms is 30 days. <br /> Finance charge of 1.5%a day will be ch'�tged on past balance: <br /> - t <br /> SERVICE TOTAL $ <br /> CLIENT SIGNATURE �J _ DATE PAID Iota PARTS TOTAL $ <br /> f❑GASH ❑CHECK SALES TAX $ <br /> TECHNICIAN SIGNATURE � `� CHECK#,: •i /`. 4 f + <br /> ` .�. •..Iy <br /> I ( To reorder tail ACE Prsnt&Design-510.832.10 <br /> r <br />