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DATE OF SERVICE 5-- <br />ANNUAL SEMI-ANNUAL <br />TIME <br />/ 2. <br />RECHARGE INSTALLATION <br />P.M. <br />RENOVATION <br />A.M. <br />LOCATION OF SYSTEM CYLINDERS Ivry?. 7-6? (IT Deofr- <br />MODEL NUMBER WET DRY CHEMICAL <br />MANUFACTURER <br />CYLINDER SIZE MASTER L5 CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE <br />FUSE LINKS 360.F <br />FUEL SHUT-OFF <br />FUSE LINKS 450°F <br />ELECTRIC <br />FUSE LI 500'F OTHER <br />SIZE <br />SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE <br />MANUFACTURER'S MANUAL REFERENCE <br />PAGE NUMBER: DRAWING NUMBER <br />VI <br />v*- <br />STATE LIC. #854489 <br />2950 SATURN ST, UNIT I, BREA, CA 92821 <br />(714) 577-5779 • FAX: (714) 577-8377 • allen@paracletefire.corn <br />CUSTOMER NAME Pk() 1:-C 1911067tr efi-feRilvt, 7Rbctt-- <br />ADDRESS /2-2S s. Efl e) A <br />CITY uN Elf -E <br />TELEpHoN(D3)24s: rg I STORE NO. <br />OWNER OR MANAGER <br />COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT <br />fl/1C3 C <br />12-r clfigbizatfk <br />COMMENTS: <br />V/ /V rilP€1 2 -S-6,T 32) <br />RANGE RANGE HOOD SYSTEMS REPO! <br />All appliances properly covered w/correct nozzles <br />Duct and plenum covered w/correct nozzles <br />Check positioning of all nozzles <br />System installed in accordance w/MFG UL listing <br />Hood/duct penetrations sealed w/weld or UL device <br />Check if seals intact, evidence of tampering <br />If system has been discharged, report same <br />Pressure gauge in proper range (if gauged) <br />Check cartridge weight (if applicable) <br />Hydrostatic test date <br />6 year maintenance date <br />Inspect cylinder and mount <br />Operate system from terminal link <br />Test for proper operation from remote <br />Check operation of micro switch <br />Check operation of gas valve <br />Clean nozzles <br />Proper nozzle covers in place <br />Check fuse links and clean <br />Replaced fuse links <br />Check travel of cable nuts/S-hooks <br />Piping & conduit securely bracketed <br />Proper separation between fryers and flame <br />Proper clearance-flame to filters <br />Exhaust fan in operating order <br />All filters replaced <br />Fuel shut-off in on position <br />Manual & remote sets/seals in place <br />Replace systems covers <br />System operational & seals in place <br />Slave system operational <br />Clean cylinder & mount <br />Fan warning sign on hood <br />Personnel instructed in manual operation of system <br />Proper hand portable extinguishers <br />Portable extinguishers properly serviced <br />Service & Certification tag on system <br />te"-- <br />NOTE DISCREPANCIES OR DEFICIENCIES BELOW <br />Al abiE <br />On this <br />this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17, 17A, 96 and the <br />manufacturer's manual and was operated according to these procedures with results indicated above. <br />In <br />11--r t) AN <br />c4P-oom <br /> <br />In pector.ignature <br /> <br />Date/Time <br />Sm- / <br /> <br />The above technician certifies that the system was personally <br />inspected and found conditions to be as indicated on this report. <br />