363 Atlantic Blvd #6 COMM22-0035 Hood System Report C�MrI _�35 Range Hood Systems Report
�� COAST DATE OF SERVICE TIME A.M. P.M.
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19(` FI ANNUAL SEMI-ANNUAL I RECHARGET INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS
FIRE & SAFETY EQUIPMENT
MANUFACTURER FMODELNUMBER WET DRY CHEMICAL
5905 Macy Ave. • Jacksonville, Florida 32211(904) 346-0111 • Fax (904) 346-0112 CYLINDER SIZE MASTERINDER SIZE SLAVE CYLINDER SIZE SLAVE
Email:office@firstcoastfire.net
Lic. #: FED19-000019
FUSE LINKS 360°F. FUSE LINKS 450°F. FUSE LINKS 500°F. CO2 CARTRIDGE
CUSTOMER
Name FUEL SHUT-OFF ELECTRIC GAS SIZE
Address
SERIAL NUMBER LAST HYDRO TEST DATE LAST RECHARGE DATE
City
CERTIFIED E-LITES UL-300 ALARM
Telephone Store No.
Owner or Manager MANUFACTURER'S MANUAL REFERENCE
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT PAGE NUMBER: DRAWING NUMBER:
1.All appliances properly covered w/correct nozzles 20. Replaced fuse links
2. Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/S-hooks
3. Check positioning of all nozzles 22. Piping &conduit securely bracketed
4. System installed in accordance w/MFG UL listing 23. Proper separation between fryers&flame
5. Hood/duct penetrations sealed w/weld or UL device 24. Proper clearance-flame to filters
6. Check if seals intact, evidence of tampering 25. Exhaust fan in operating order
7. If system has been discharged, report same 26.All filters replaced
8. Pressure gauge in proper range (If gauged) 27. Fuel shut-off in on position
9. Check cartridge weight (If applicable) 28. Manual & remote set/seals in place
10. Hydrostatic test date 29. Replace systems covers
11. 6 year maintenance date 30. System operational & seals in place
12. Inspect cylinder and mount 31. Slave system operational
13. Operate system from terminal link 32. Clean cylinder& mount
14.Test for proper operation from remote 33. Fan warning sign on hood
15. Check operation of micro switch 34. Personnel instructed in manual operation of system
16. Check operation of gas valve 35. Proper hand portable extinguishers
17. Clean nozzles 36. Portable extinguishers properly serviced
18. Proper nozzle covers in place 37. Service & Certification tag on system
19. Check fuse links and clean NOTE DISCREPANCIES OR DEFICIENCIES BELOW
COMMENTS:
On 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 manufacturer's manual and was operated according to these procedures with results indicated above.
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SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMERS AUTHORIZED AGENT
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
WHITE - CUSTOMER COPY YELLOW- DISTRIBUTOR PINK -AUTHORITY HAVING JURISDICTION