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' � tVARDINI FIRE EQUIPMEN�T COMPANY <br /> �ST. PAUL, MN. 612-483-6631 • ❑�FARGO, N.D. T01 -235-4224 <br /> RANGE HOOD FlRE SUPPRESSION SYSTEM <br /> INSTALLATION / MAIIVTENANCE REPORT <br /> �INSTALLATION �SEMI-ANNUAL MAINTENANCE ❑ANNUAL MAINTENANCE <br /> � <br /> Date of installation/maintenance /�-- " � �� Time in �� O Time out //.x��J <br /> 1 . Name/phone of facility /�r`nne�"e;�v�� n e.✓t�.P �o� �! e lqt'-�-5 <br /> 2. Address of facilityo'Zo��p /V�r�ts�inr� l,r,`J� ����w��S/� ��''2 `1r��' 7.�G/ <br /> 3. City, state, zip L�.� � 3� � <br /> 4 . Mfg. of. system ANS �_ KIDDE RANGE GUARD OTHER <br /> S . Dry Chemical Wet Chemical Cartridge Operated <br /> 6. Where system is located �G�C � O�� • <br /> 7. Model of system f ' �, � Hydro date �'� <br /> 8. Last maint . date1�u��- �'c� by ' ,� Co. <br /> 9 . Manual release(s) operable? ;�Yes ❑ No; Automatic release operable? <br /> �Yes � No <br /> 10. Mechanical fuel shut-off device(s) operatior,al? �Yes � No ❑N/A � <br /> / <br /> 11 . Electrical fuel shut-off device(s) o perational? ❑Yes ❑No„�N/A � �!� <br /> 12 . Do devices in 10/11 shut-off all fuel under hoods? �Yes ❑ No <br /> 13. Fusible links, how many?_�360° ; 500° Last replaced �c.�►�t. Q �� <br /> 14 . Nozzles checked for proper coverage and clearance? [�Yes ❑ No <br /> 15 . Nozzle quantity/types Duct Plenum UP Broiler <br /> Char Broiler o2 Regular surface Other <br /> 16. Cyl . Weight(s) �i� � ( - Cart. weight ���r2 dZ-- <br /> 17. Do exhaust fans appear to operate properly? ,�Yes � No <br /> 18. Is hood clean? �es ❑No; Are filters clean? �Yes ❑ No <br /> 19 . Is sketch of hood and appliances on back of report with dimensions? <br /> Ye s � No <br /> 20. Does system meet N.F.P.A. 17 and 96 codes? i�Yes No <br /> 21 . Has system been sealed and tagged properly? �'Yes ❑ No <br /> 2,2. Does the hand portable fire ext. in kitchen meet N.F.P.A. l0A? ,�yes � No <br /> 23. If "no" answers appear above , is non-compliance tag attached? � Yes ❑ No <br /> 24 . Comments , Recommendations <br /> /T ��5���i.� ^ ����, (''lr-1�ean�. <br /> Installer-Inspectors Signature Customers Si�nature Printed 'Name <br />