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CUSTOMER
Name
Address
City
Telephone
Store No.
Owner or Manager
Range Hood Systems Report
A.M. P.M.
ANNUAL SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION
LOCATION OF SYSTEM CYLINDERS
MANUFACTURER MODEL NUMBER WET DRY CHEMICAL
SIZE OF SYSTEM CYLINDER SIZE
FUSE LINKS 360°F FUSE LINKS 450°F FUSE LINKS 500°F OTHER
FUE
L
S
HUT-OF
F
ELECTRIC GAS SIZE
SERIAL NUMBER
NEW OR LAST HYDRO TEST DATE
LAST RECHARGE DATE
MANUFACTURER’S MANUAL REFERENCE
PAGE NUMBER: DRAWING NUMBER:
COOKING APPLIANCE LOCATIONS:
No
2
0. Replaced fuse links
21. Check travel of cable nuts/S-hooks
22. Piping & conduit securely bracketed
23. Proper separation between fryers & flame
24. Proper clearance-flame to filters
25. Exhaust fan in operating order
26. All filters replaced
27. Fuel shut-off in on position
28. Manual & remote set/seals in place
29. Replace systems covers
30. System operational & seals in place
31. Slave system operational
32. Clean cylinder & mount
33. Fan warning sign on hood
34. Personnel instructed in manual operation of system
35. Proper hand portable extinguishers
36. Portable extinguishers properly serviced
37. Service & Certification tag on system
38. System UL-300 Compliant?
Yes
1. All appliances properly covered w/correct nozzles
2. Duct and plenum covered w/correct nozzles
3. Check positioning of all nozzles
4. System installed in accordance w/MFG UL listing
5. Hood/duct penetrations sealed w/weld or UL device
6. Check if seals intact, evidence of tampering
7. If system has been discharged, report same
8. Pressure gauge in proper range
9. Check cartridge weight
10.Inspect cylinder and mount
11.Operate system from terminal link
12.Test for proper operation from remote
13.Check operation of micro switch
14.Check operation of gas valve
15.Clean nozzles
16.Proper nozzle covers in place
17.Check fuse links and clean
18.Hydrostatic test date(s)
19.Next hydrostatic test maintenance due date
COMMENTS:
On this date, the above system was tested and inspected in accordance with procedures of the presently adopted editions of
NFPA 17, 17A, and the manufacturer’s manual and was operated according to these procedures with results indicated above.
The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report.
X
SERVICE TECHNICIAN PERMIT NO. DATE TIME AM PM CUSTOMER’S AUTHORIZED AGENT
DATE OF SERVICE
TIME
ADD picture(s) of appliance line(s) showing nozzle locations as ST job attachment
YES NO n/a YES NO n/a
N/A
LIST OF
NOZZLES ON
SYSTEM
**ARM SYSTEM UPON COMPLETION
*
NOTE DEFICIENCIE BELOW UNDER COMMENTS
HUNTER HERRIN JOSEPH BUIE
PIZZA, RANGE X 8, GRIDDLE
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