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�� NARQIN ! FIRE EQUIPMEN�T COIVIPANY <br /> ST. PAUL, MN. 612-483-6631 • ❑�FARGO, N.D. T01 -235-4224 <br /> RANGE HOOD F� RE SUPPRESSION SYS�'EM <br /> I NSTALLATI ON / MAIIVTENANCE REPORT <br /> ❑INSTALLATION �SEMI-ANNtJAL MAINTENANCE ❑ANNiJAL MAINTENANCE <br /> Date of installation/maintenance ,1,2� '��� Time in ,��� Time out <br /> 1 . Name/phone of facility ' B -e <br /> 2. Address of facility o� �.d L�. r�` ��2� <br /> ' <br /> 3. City, state, zip Lc�a <br /> 4 . Mfg. of system ANS �_ KIDDE � RANGE GUARD OTHER <br /> S . Dry Chemical Wet Chemical � Cartridge Operated <br /> 6. Where system is located /�/�jr�-1-i p �p <br /> 7 . Model of system RF �� , .���' S Hydro date � � <br /> 8. Last maint . date;�'�_ by ��✓���`n_f �cr,� Co. <br /> 9 . Manual release(s) operable? �Y.e�� ❑ No; Automatic relea e operable? <br /> �Yes � No <br /> 10. Mechanical fuel shut-off device(s) operatior,al? �es � No ❑N/A <br /> 11 . Electrical fuel shut-off device(s) operational? ❑Yes ❑No�N/A � �r <br /> 12. Do devices in 10/11 shut-off all fuel under hoods? y�'Yes No /� �/v <br /> JL'' � <br /> 13. Fusible links, how many?�_360° ; 500° Last replaced �._.)t(yt� <br /> 14 . Nozzles checked for proper coverage and clearance? �1Ces ❑ No <br /> 15 . Nozzle quantity/types �`Duct / Plenum UP Broiler <br /> Char Broiler Regular surface Other <br /> 16. Cyl . Weight(s) � Cyl . pressure Cart . weight �6 l� p� <br /> 17. Do exhaust fans appear to operate properly? �.es [] No <br /> 18. Is hood clean? ;�Yes ❑No; Are filters clean? �Ces ❑ No <br /> 19. Is sketch of hood and appliances on back of report ith dimensions? <br /> �Ye s � No � <br /> 20. Does system meet N.F.P.A. 17 and 96 codes? ,�Yes [� No <br /> 21 . Nas system been sealed and tagged properly? ,�i�s � No <br /> 22. Does the hand portable fire ext. in kitchen meet N.F.P.A. l0A? �s (] No <br /> 23. If "no" answers appear above, is non-compliance tag attached? [] Yes ❑ No <br /> 24. Comments , Recommendations <br /> - K��.Q n�v � �n �� <br /> Installer-Inspectors Signature Customers Si�nature Printed r'ame <br />