Loading...
HomeMy WebLinkAboutHood Cleaning Reports 2013-2015 - Correspondence - 10/2/2019 Gilford,Lancaster,Nashua,Hudson& TRI STATE FIRE PROTECTION, LLC KITCHEN SYSTEM INSPECTI Newington,NH Remit to: Page 1 of 2 Telephone:(603)293-7531 26 Hampshire Drive Inspected to the current version ofNFFA 17A6 Fax:(603)589-2051 Hudson,NH 03051 www.getfireprotection.com WORK ORDER#: 10387778 DATE: 05/04/2015 01:00pm EDT CUSTOMER ID: BILL TO: BENCHMARK SENIOR LIVING SHIP TO: BENCHMARK-ASHLAND FARM AT NORTH ANDC 40 WILLIAMS STREET,SUITE 350 700 CHICKERING ROAD WELLESLEY MA 02481 NORTH ANDOVER MA 01845 Phone: Contact: Email: Phone: 978-683-1300 GUST.PO# Model#and Type: RG 4GM X2 Annual Semi-annual Recharge Installation Renovation ❑ Z ❑ ❑ ❑ Hydrostatic test date: Cylinder 1: New 2011 Cylinder 2: New 2011 Cylinder 3: Amerex Ansul Buckeye Kidde Protex Pyro-Chem Range Guard Other ❑ ❑ ❑ ❑ ❑ ❑ 66 ❑ Single Double Triple Other Location of System: Cooking hoods ❑ ® ❑ ❑ Last Cartridge Test: UCH cart Year Replaced: Grease Accumulation: ®Normal ❑Heavy Fusible Links: 3@2015 360 degree 2@2015 500 degree Other Fire Extinguishers Last Inspected by: TSFP Date: 11/2014 Yes No NIA Yes No N/A 22 Manual and remote set seals in I6 ❑1 Interlocked with building fire alarm ❑ place El 2 System fully charged V ❑ ❑ 23 System operational and armed V ❑ ❑ 3 All seals intact V ❑ ❑ 24 Slave system operational and armed A ❑ L 4 All appl.properly covered V ❑ ❑ 25 Fan warning sign on hood ® ❑ ❑ 5 Duct&plenum nozzles covered V ❑ ❑ 26 K Class extinguisher in cooking area V ❑ ❑ 6 Checked positioning of all nozzles ® ❑ ❑ 27 Proper ABC ext.for other areas ® ❑ ❑ 7 Hood/duct penetrations sealed V ❑ ❑ 28 Fire extinguisher properly serviced Z ❑ 8 Pressure gauge in proper range V ❑ ❑ 29 Explained operation of system ® ❑ 9 Inspect cylinder and mount 6e ❑ ❑ 30 Monthly inspection documented ® ❑ 10 Operated system from terminal link ® ❑ ❑ 31 Explained operation of fire extinguisher 11 Checked cable and link position V ❑ LJ 32 Certification tag on system Z ❑ 12 Replaced fusible links V LJ ❑ 33 System installed per U.L.300 13 Checked operation of manual release Z L] ❑ 34 Owner's manual on site ® ❑ 14 Check operation of micro-switch ❑ ® ❑ 35 System cartridge reinstalled ❑ 15 Inspect gas valve Size: ❑ ❑ ❑ 36 Safety pins removed ® ❑ ❑ 16 Pipingiconduit securely bracketed V ❑ ❑ 37 Checked cartridge weight ® ❑ ❑ 17 Nozzles cleaned V ❑ ❑ 18 Proper nozzle caps/covers in place ❑ ❑ 19 Clearance flame to filters ® ❑ ❑ 20 Separation between fryers and flame 1Z ❑ ❑ 21 Exhaust fan in operating order IA ❑ ❑ ®THIS SYSTEM PASSED ❑ NON-COMPLIANT (Vote:Improperly maintained exhaust systems and/or non-compliant fire systems may fail to suppress a fire. .L..: II G. Co!A!� r!■& U s5 IL■IUMt$: i..-L._-. 4-AL.tl�A 4 ClE�i`.af�+!—�+.1"FI�tLra�'i i±Y tciii+:k'•::+I.a'EiCctsis3',i'��5s�+'iU�, r,olTlr�rb: Tf(Tta Fail t'�Sia+iir.idp'wli ii,.'ii,ii, JTcfl hf)'1-_^!t'4.7!5.'•1M 1��5,rls:rn hlh�l l7^f15'1 U3. f_•,T.r� :.h -_.___...... ____ i,/iA•7JLi i}Ili rF it a:., i 141113:)..RdJtf4II:'-S�•IIt: kY/O K.�. arr: 9aF it aRR.. I BENICHPAIARK=+CI,II?R LIVING I 17i=NCHNATiRK;EHI IK Ll Vi!iNa A_1"!I AI;p rA•F.M AT It1Q17 A ANnO;r D ? l AT hlf1C?Tl.!Ar.lnr Lrr .,, Im 1 a NOR TH ANCJ 1=11.NIP, VI iSil! t OP T H ANDOVEP.MA V'Iif4I55 I Plt)f nn- 41 lf1-[•if1:S-1:i[I[I I rcm. r rilltrrle: I. u r,I° F'i: -FralL'j Dk r L DUL:2� LAv LIATL L ei`ila: Lhl""I'1 UJ h::•, i"Yii'Y'.l!i•`1.IF'•1. I",!'1"'C4 ii''6'L"nl"L'.6•I!^.i,l i'•V'C=1"i"'L: inn Lt [ ._.✓:.11!..�.�.I. -✓r "-�F:Yt) ... 3filit Al_!.f I ._...._. .. ._..... _.-.,... .. .. ............ ..... .... .......,. .. ....__ ..... ....___ ......_........ ............._... .. . .. .__...., ....____.... .. ______ __......,.__......- 1 f�`aJL:A•I;I"AI'Jdl €il'.�,I:fit-Lh'f�"IF'I�I�',,�'I'I��iJ'd .....:. ,,,..�.., __ _ _... _._.._ _.. 's r`+"NDITION or rlLTEr' fy,, 11 : r",h.m.JJ_Fi�i!^ii?(3r.;,I,A.,riaii it ri..�ivi rv'r ... _ _. ___.. ._....... ........._ .,__......... .....__.,.. E-ANI f?I IT Rf r=. I; LIJIm-1,:r CEAL CI-EAN Our r orAT, LJ 10 AI:L R it Ir 01+Alidt�CLLAk! — 11 Q.FANH00D CLIC,T&FItTER, 12 r_a� ror,r+rorcr,or Er ioi,! k17 +%i'i.ii=.i.3 1•r, ARE THERE C1j?f_ASE 67 AII`JO ONTI E ROOF? 1c; nr.u'„',l.,!I�...,„.,1.,,�...nr,r...✓°•n-r•:-t u•'°r•+c^,ram.:+rv.y.y,..., ttl:':r.ir•;.; — iiiaivi 1€; PLACE, t/ 1`-+ '�•L.l1_�i-i�Ll J i t II-LI AI it�I`•i3L tPlLtv't'I'`v I'LLi"i•L)i' g7,7 _ _ .............. . .. 3(7 Ni*IytltStfE 4171, 1 i+'Z14;H FiaL]tWilsi I k 21 CHILIT Orr LIO ITO ILOM.DOOR ' !�',yr�vr.t I'r nts,,,.,:.;l.,i..rv.sl-.•jL it.,yrj__j,:n:,'s-:ms+•••��.•s 'Si-iir1i,rii,.icn •riAr 24 MORE rORTS NEEDED? i+ i-itsl-ri i ii'N"tii%r .'iif,,i+i i.l ir, i„iiiiir �11v1L1•!r !L;•F LAr lA . .... ... .... .-. . ..... . ..�. _ ".. ... .... .... .. . ,`..... �.... QT!t PA RT„a 1 t4 f C F;17 !V T P in•21.1 I L171!"`rr 8_RR£m IF_!T ; I I ! ! I I I I t I I I r 1 I :'(H)fl I I"IOOI)t(I)t 1pl !•ii^h`A!(;F^ (.At I JiiJ� DTg^TAl ...i t I i I I r_i t.a..i+uw - �'' '..MT4MEP S4+-s!(7NT!!fE DAME C!-!fl!tClIEP...�!Cs r=•f}?!TE 11/13(2014 1004678_4b82b6986767bc5f400d5de81469b462.jpg(2522x3264) Gilford.kancaster,Hudson s Newington.NH TRI STATE FIRE PROTECTION, LLCt KITCHEN SYSTEM INSPECTION Yataphone;(6C13)293-7531 Remit to Page 1 of t &x;t603)589.2051 26 Hampshire Drive ln5oUed to the state adooe?d version otNFP i7R 8 5 www gethreprotectiontom Hudson,NH 03051 WORKORDER DATE: CUSTOMER ID BILL TO. SHIP TO:�Gnv6nrr�r, ti a 'C nc! f n } t� h Cl- cs t� ,Ar1J&ver- Phone; Contact: e- E Phone: � mail OUST;PO# r Annual Semi-annual Recharge Instai�l�atian Renovation Model#and Type; ❑ ] �� fin— OtherC linder2 s ` Cpder3 Hydrostatio test date C tinder 1 1Y A e ex Ansul Kid❑de Pro❑tex Pyro-Chem Range Guard El �&' Single Double Triple I Otter Location of System: v V....e , �, ❑. V , ❑ ❑ Yes No NIA Yes No NPA 1 System interlocked with building fire 22 Exhaust fanin operating order 3y alarm 2 System fully charged 23 Manual and remote set seals in place 3 All intacf.No evidence of 24 System operational and armed B tempering v i All appl.properly covered wi correct 25 Slave system operational and armed 6 Duct&-plenum covered wlcorrect � � 28 Fan warning sign on hood � ieZztes � � 6 1 heAked positioning of all nozzles � _ �^ 27 K Class fire extinguisher in cooking ...., F area m 7 Hoadtduct.penetrations sealed 1 28 Proper ABC fire extinguisher for other v areas i ii ..,F.rrlssure gauge-In proper range r 29 Fire extinguisher properly serviced 9 aspect oyI rider and mount ( 30 Personnel last an manual operation of system Ciperated system from terminal link 31 Was the monthly insp. performed by the owner r af� r„ Cec1d trav )of gable and link 32 Personnel instructed on use of:fire erd j �acalt ftisibla Itnks J� 33 Service and certification tag on system 9fac and claaned fusible links 34 System installed per the U.L.300 standard faCion of manual release 35 Is there an owner's manual on site #lion of mtei€a switch 36 System cart,secured/safety pins removed 1�a5Valvt Size 37 Checked cartridge weight L-®: r, Qiyl peourely bracketed _ Last testo 11 A�epl. a 38 Grease accumulation' Normal ❑Heavy ' `11 `�4�iapBtCdvers placev 39 Fusible links. ( 360 degree ❑450 degree panne'to.f ter"s �_m C9500 degrees ❑Other � 1 ti�r0 taetween fryers a4 Fire extinguishers last insp.by._ gate: th s rlS SY' TEWPASSED ET NON-COMPLIANT httpsl/s3.amazonaws.com/production-attachments/1004678 4b82b8986767bc5f400d5de6d469b462.jpg 1/1 _.................. 11/1912014 1004735_7372bl8d4c4754c1f919717971cOe3dc.jpg(2522x3264) rwltrliwtµts ss a Waw s wm Nwurwnr taa,,�ftt T I STATE DIRE PROTECTION, LLC K11TCHEN SYSTEWJNSP CTION�'srmh5!r ,15d5t�ta5°� �� FOW(%yWA 0)51 Remit W� Page I d,2 'WWW, krlmji�Croru tlt5n 26 tl5rrnp dre DrNe i0AP MAfto 00 9698, 4wa Ord m'afNFP,17,, ,9,g HWISOR,NH 03051 P1uMW t;a rlk t. CM11,; c sd Huai g W rnrnu t Recharge 1 n tWWU Cie �patio ro 14ywfrwt ' Stlisk7Igr t, °° a„rt Pyldrndr sr nStO Kiddek fttex� Pyro-Chem Range Guard Other". Yes No NPR Yes No a IA dkeo lbutWing fire 22 Exhs ast tarn in operafi ng. rrder /irpat ' � ttal rgsd u W icy remote,sus s in tam ; dr�t ! s rapt System operafi nrn g and/agneo �� rdpg rmt era Bsv systra ragatlorwsl-and rmsd „ %/ �'rr wwryma rt t ratrr t '26 Fa n wrwrarni ng saga on hcnr5rrt 1es z Class fire sMmwnrkncrrarearrorrurr area ,.. ".� 28 �°reratror tirt, tatk� tshsrtrtd9 " I PersonnoW dust,on rnanual rnp r ktwwan of, gt , W wd ,the monthly insp,pe;domte(t by the owner 11 Peruonnel trrstrw4ted onuse of fire eKt .� 33 Service and centftatjon tsg a5rs systelli t 5 SYsta irwsWed,per ow, tk t,300 G � � d Is tlnasr an owner's wrrannrual on sits OM OWL parr dt5 4*pins / rw5aan6ci I11ec9`st dwr swwewght 2 Last to , apt . Grease arualttra �arrf 8...�hurry / ntrslbWs g6nBrs �N d gd �% 13 45g dsgre r � ISg d o Oiher /� l%��� ///� 4 br st�ragtashrs Isst urea hY —r-1 .; o/ ���f �`LI � https:/ls3.amazonaws.com/production-attachments/1004735 7372bl8d4c4754c1f919717971cOe3dc.jpg 1/1 s r=n auu�ao-�eZ—b Fc�---Ti IN 1R1�d—.-- 1 Q Qro Q�� Q®d �# a Qom@ . = ® @9 -�i€:"s �'d $ � eea s spa arm rr - - C. al_- 1_ �1__6.._ r,_..rT L�nlYlu,LCIILfl�LCI l Fvfiffi IYc, 14clnh I V: IIAl P Hudson&Nevdinown.NH 26 Harritshi e Dr tlelj � 'n^.Tr-tee Il..�___ nriln.�nr.1 t-USLOIlle~I !U. V VJ'dC�"!JJ I L Y_s'I r,1'i 11 L[�Y+I (Fax) 603-529-2081 F1FrdC_nlAnll rl IIr: I BERIGHM}il•vK! :A=NIUHLIVINO I FENCHMAH{,�.5'1lxllUH'UVIITJ 'rill AND r' —1 'T olr�.nTll 611-11rn I nr'I L) r.nai- ranea PT P.IY,tTrl nnlr,r„Ir-r-I nc.'I LfVVV In14Fi9n1 VVI4311 J't1vVVYLl4 I n._1 ILRHl�it'll ilVi n! FiLa 4l,rnIVVI VLr, 700 CHICKERING ROAD 1 700 C'HICKERING ROAD I.1r.nT11 nhlr..^a err. air .nnr v Vl',11V IVVL!V LF+„II YIVTJ I ,vt r4111 nrvl_'�t , lr! i"t� Minna. nip-FR,?,l;nn I I Fax: I rnone: L-Vr 1,1�VtT nnL 1`,+Y iri' Ln E��.V Ir'. •5^Y I r-T'r„Tr"r:!':M13 r. '41... f.J LRJI i1n IL L1-IVL. r'1A - -I 'KiltfilAla. t'Inr'!71 lnr3n r-r.r.l!',nl�4tJ LiI Y-:irlr. iL14 air, L IV'�•, ] 14L'vLL:LIV41. L JVI 1 14LUJIi11v I v 1! L. SUUNIAUL nA1.ln';lPF77ArPPPr, t_UUMNItN1: IRINjE4IIuNURIIE=RK Y65 V UIU(;K[=FA14CY A !'-I Ir»li rA.hl P-Y"f.n f.r2r,rir'n r _ 1 -1 ILL-Y41F'lV�l��l Vihl Iw..l1 Lf4 VI Ll,a'll iti_Iv :q (..t ir.1131Tl(-YN OF F11 TFR ✓ �;�( � �7y1`id o f 'll V r.an,- IN0 1..r31 , -- 14LIV, VL ruVV WVllnllL-I Lr Ir4Jr. -_----_.-_--- � HARE 8-.ULLH:PI HUUU,LU.;I d.FLLP UM, - — 6 PEMCIVErI PAN OUT PORTS 0 }14t 1'ItII�VVe VLi T�V1iVi141t rr.Y�.1 lRI]r V.1111 I:2t [I-�r.rr,nl Irif-t'I'ri Irr, - - - 111•_�Ifr 14LJJLl14L v0.�'!JIILI4 Y5 ARP T HF-RP A l tl I�Il Ft r l F-A F:.-;; - A rlrAl r-1.r-A IN'(�,i 1T Rf,.r T-M IY n14L 14ti.Jr �14nlly� �LLrll4. _ ___ _ i'1 f-I1-tll!l a-QUL' Bill-17,`.NII IF-1+'ti: r l Ila4L r!�r.A:,L,.`LL i _+iv':..'i i v L 14 'D tSIEK111AA-lN1AlNl=U / 15 IlF7F TNFF'F f:Frf=JiG�CTG€I,I f7h1 TI-IF Gf iTiF V / It A14L T1 IL L13Lh'1W441Y1`.rllLliu LrlL�.�L�!t,i,l. -- �A/7 -T 3 i Hl=-ARM IHE r1KE;SUFFHLa SlUPJ�vb ItPA iR PI AC:F.ri-9Ck PR,,ON HriM 10 in rnW3[mVrLVTnLrn3L.•'i ir'�•rvnnlL,,�rlill-rt�iL�i. iDjn: 171 _ -- sU HE MIUVk ALL IHALH f HLAA`:I1 t 2i:gui rnFGi IruTr�r,rtrrsl�,t1G �� -- �rti'nlnitnTnl:r 'r"nnr n brr�n nhTVrnr 17 LL VIV 3 ItL.ULI LI4L R1L n! 14LJ: 94 6Ar'YPF-PnRTS NFFnFF'i^ -- -- ��r 'nnr rv,�€,1ralTl nnl -- -- dJ Ih`f Lrl L-Vf1V111 L?IV 2b I-NEk-XI.iNL:5Ht=U-IIUP.IUUEUAIE - ------------- - - r- - - --- '- - ----- ---------- - r� \ Y! c/L{ (�J( (� ' �'/� f �7L/i U ht l CCe•/� ���t j� oo�� ci-�!� I4P�S Llc��(- !��I 1/i y P i If C� .e CIeu,, et - P- . .� a e I-I-i-SJ I nA rl—, I ri §- £t f- m i M-r i l`,Ro I i!T'kl F- I it F,A,-,I irtIT I I I 1 I ! 'fit I I c I ! I 1 I I 1 1 I I I I I I I ] 2nru Iunrna.nllrT �€ nrEr; E 1 f 1 '31.1©IIJ IN:L I I IMAI I I -1 HILLINU ALUHEi j':�CUM-NMED t-_ 1 oC 06466 rlISTr1MPRSIGNATIIR -�F1ATF TFC MIMAW.9 P1GMAT1IRF-DATF (� 6/4/2014 399842_4572a6079e2193325943d3af8ee9c4bf.JPG(618.800) „ 1 JPIR„r l ar7%,/N 1�1C ',"r2 pv,rn, /u: ,pn0i51P/rani;; do,VIONNOWINI, /A, ,hti,/rear, ,'6��1�,�lff�✓�r ��� � �� v0IVnw ,1J'' 0 airNr',n�vWfNW{'�ri `Y(Nu�l�➢ fr���� '�'Gri, r '! N 1f�N'' , 4iv DJu7"' AM „ ,,,,,,,,, ,,,,a r,r�ory .rrrrrrrr,r ,r i/nr, r rrr,ra,r r r ri r„r,i.rrr rir a> �� rrrrnmr�NO y nFavi?r�,a✓a�rrv+wrrrarm,rt^urrsr i�,nrrN Jvi7Y,ag�'NNa+'+%N,' r mni n;lr ✓ rµ"a'druur r,rr rrr. nn n ,u uu�rrnu�lrr pi mrmarfb;'d,WJPadA�NyY'41 f1d7N1 fFm'Sr�9y;w'�i�4'N ON?1yYWyrrf/i fiDlNla�.:. a,v,r/by /Fwa r mm;i i ��f ✓N4St( ( YXM r' Hl IS, , f 411* r,"r";r,,i,✓"„ ,c;"%ii ,,,„i „//i/rt%/l/r Jr Jsri 1 r/i/aU y e �%�Ih��,�'7�/r�Fva r r nrrn r r,�w Jrrfivm�lf r/r�� :. +`N4mn��'rnirrr,ry r r„� � r rr Jy� 1 �'Y irr/Il/ 10, rriv%T //%r///1401iir v a„/((jJ it PlliJh� / rr, u. e , r e ,.,,,w/m/c, sot"/, r , 1,i ,'I//l(PN'mmm,rJ a",,PlI vs,"�llOJew" i„i o'w19D!��IlldSh� „%�Ua1 is �a7 ✓ ,a r r/%rrra „ „ry r„odl rIN%i%/f��4YINiT „a!>rrryf/bir/i,hrJ'I�i YM/A%1D„ 9%/olyi ri //G v w'7r r r/ Gd nlim xW /iJJrjlV9 lk�/liryr J'J l flr n, //e QA! D� r reorr r, btu m rr rriorr riv 6JI� arryVwf '4'kra % /ir rrril,rP/rii a/ r Prl'a� > ff mmj(AYilNtm / y/ iW"I"Ofafl4rom ii rcm a/Jrm Nr mnriifirr rr irni„ 1 /ir fi,/r it %/i G/lllfl6?Allr %llbD%%!%�fiiii//fir f/!✓v/i OFF ri/IJ' i/%irk r i%%r`lr//AF✓ //r%/!!I%/r r i/J! /r%re/9/i/r j nJm%RHNiv/iK^%%11�r� � i i r / I!i rr/rrr/ r� r i i� r rii 4 /,U1%ii 1'4Nn''� N/rg1(fV/fnNf oil ' %f N xli/i'"r ra r r / r I / ' r / r 4; i/r/y�i /l7!iti/lrir„r1i111,15ViUd ffa i I7 // /! ( �; / ^!r r/G/ rbrllr 31// r r / u /r �" fl/rawrrNr'9l YItsNy AIroN N �1 � 11" G,,,, r ry' / h / Fir FAi rii//r Boom r H/ mio aifirUi rlrr i/�r�/ii �i/ i m�/ i r r ON � ie �� H//'r yfiYGfi4/m�9JIN� � 111y J1,�9W��llVb�/�1fJi^� �/ i re r / r �;�,� ,JytJlldNw»/I�N�Vi��j,1,14�J1 �N1N�i�l4sy��iu�Vi�/1D1NN«W�1!f�Ni(( r Fr JY✓O1�Off/t ow/OfNO yd, I we I1w "glumamoff''o ��� ��, ��j14Sgf1J1i�Ju�J��IYf9J1HeYN�Jr filYrit��m ;)tPV`rr�y�Nlilr�>un7mlCm �. „/ y1N fylM N1S gofol,urow rr NJrcr bi aGnrr/ f JIl'! t�'jD3�`I°Nir'iNiiuor 'rrnrvi/Jr,''r/p rr„�G ,ar�o/�lmiaUyr aN,i/%W ar1N�aWour6ai/i Ar,rnr�psX � rr,r,,w m� " https://s3.amazonaws,corTVproduction-attachments/399942 4572a60?9a2193325943d3af8ee9c4bf.JPG 1/1 t� r E �'4 ��RI STATE {h,�hV� T T���1� PROTECTION, , C,, a td w 4 i ` ° , IN Date f 3eVVIP`k° rib£'r.'�Y="Y to fit% f i C.X5 `51, Pva rr-vo td ,"r"i C � a� and+4 14,�aaF I LL y W � � A FARM'�.��d ,� Nc F, 'v`,��....4_r°R P i�Y la„i T4,..g���t�h'_;31 h Jet_?E�Y�e� ^r° •..va','s�� .'`a`s F Mr, Oila .�a f00C,�i^rkCl��.RRK k�('atk`;a MA,>dWEms, A isr 'llb, Flow SMARWOO F ex, 66"'I�:A6-;-`�F'. .k..:,�'.`n��Bf`,� a""w.rr`d'��;'.,ki°s u. w.i �m'1:a E�.4.I 'i:' 'v°`•,t'4�Bs.Y :ut �aCP x w.l a Anr%u4 Fusg4 s-n;M +haeE-,mg ' fi���cau � < 8,_ i "*MAC 4e a:p� .. �'� z s.r„ aaa,• a«a �t tyy _�., ..� _ a ; �. ] >,e s cf �t C _ ................_..._...... ITO9W'� �1 tr ;a at i¢k 6 z,3C; Ba €ia to d 4` 622 FX�Iuu ft.knR Pray xUtq x6eir m FC,`!1 Utz t e Li k �{z9 P4'a,B'tl 'd3"t fUrr'fl 7 ¢st 44C'd; d x Pon "�. , ,d - ,a a as tt�6 No Ov I � 4 z f c (, a � � � ' �, wn sz<rerz�lmni and Grp ad 25 z r^r e wo.r W pit orM Mo WtY.r d 5 DMA R Pon un, uu,,f ed Av A,,c t rvz �.._ � on a �C� z t,co nu z d f�Um O a r�#;��a is b y ta>z"g Wee I � z > Fa'0 awt d a;u t aiR tt z�"ar �' a U t YRt3ar r AECare rPxtYv quq l,ktersr a(h� �"�� n ...- u d{ En rf.cngp a 29 �S'#ark Irh-'�C.z94!"fi€�t'Wn ay[y,,e)nLr,@d - a .., 31D P ffn;rivvMatstsit.mrnua rapesarjor,:a 10 cyWIN SPWM owl wmnal W u .y,� '` �a ���t §�l��t�dra aIns` ��=�4 frwr��"� � — ,. I I h # W 1" d Cole,.Ib o Ei4h 4�twwn d � � r ef_,�ornnfA„aa,tna �r�v o dae l n eA x ¢ ,;h end.:k°zctt`Gerlil ak' m t .(t-r'tr.t ��h'tr�`'rtask 'lontLifr N; �r �1.;g; -PoE� 3 a losined ffis�4.O, d t t f,m"n miixtalkt 0 p es€ s 31XC I ¢6 af cl, t Log Y0 two to m('t 2kffiabs>W 4 .. _ P S vrt.4�xzst daif F�rG 'w=laak ... ... 11:ePn 0 tI.=._as4. rrod 2 �- ¢I^tat t 1 €'ikaE r i tFd CY ISO X'ESC P1 e a(r 7 a _a ; sr ;'Ikt a ra s' & Y � a s�61gr(ar ua ,yw, � PASSE ,. . ,... Ell NCO MOT .'.k tS be aft ry i Gy a '_:.7� I� ;3 dCh r.d�tB at,4 Y,na,. a - Abbi WmpwV nvM* a, xg, e aid/or,nun=7WHAW ff �mfstau,ui sn a fl toM swuppse'ru a the,, coltwx you Within budneas dayx d - ,�in AC, R zG�e € �' IE Y Y!" 5P A £!' � I � f y .. ...,.. ...... _,....,� ...... >§ r'kk,€ £4, bh. a dPTRUTF, 2>G a ' _�.. _....._ _.i . ............ .......... ( t GTk 'Rssr F t( E 4 Al z'�viAj`€ "a..4..'41I� .!,�K F Ge,a3 r",z"k -,._.�. ,,. A s., vz � ABC a C,K'111 r e"k6i Ei-,11';Ki N40Y s.aRI""" .,_Pk f4,,3,?,4N s M, DXF Gllfora,Lancas i, Newington,NH 84 Lake Street ) (Tel) 603-293-7531 Nashua,-NH 03060 (Fax) 603-689-2051 r BILL TO: SHIP TO: KI d r�h -goo � v Phone: r �i Fax: Phone: COST.PO# DUE DATES: FX il Karl KS ZS EL AL SP CONTACT: COMMENT: Model#and Type: Annual Semi-Annul Recharge Instal Renovation Cylinder Cylinder 1 Ender Z Cylinder 3 Hydrostatic fVdA�-P fv1?" Amerex Ansul Kidde Protex Pyro-Chem Range Guard Other test date: 7-0 fl ZOl f E= 0 0 El Location of System: Single 0 Doubled Triple Other ................ _..-.. . - Yes No N/A 1Tea fro NlA 1 System Interlocked with building fire alarm 22 Exhaust fan in operating order 2 System fully charged 23 Manual and remote set seals in place .10 3 All seals intact. No evidence of tampering 24 System operational and armed 4 All appl.properly covered wl correct nozzles 25 Slave system operational and armed 5 Duct&plenum covered w/correct nozzles 26 Fan warning sign on hood 6 Checked positioning of all nozzles 27 K Class fire extinguisher in cooking area 7 Hood/duct penetrations sealed 28 Proper ABC fire extinguisher for other areas 8 Pressure gauge in proper range Xt 29 Fire extinguisher properly serviced 9 Inspect cylinder and mount AL 30 Personnel inst.on manual operation of system 10 Operated system from terminal link 31 Was the monthly insp.performed by owner 11 Checked travel of cable and link position 32 Personnel instructed on use of fire ext. 12 Replaced fusible links 33 Service and certification tag on system 13 Checked and cleaned fusible inks 34 System installed per U.L.300 standard 14 Checked operation of manual release 35 Is there an owner's manual on site 15 Checked operatation of micro-switch 36 System cart.secured/safety pins removed 16 Inspect gas valve�"A4ee�1 tCC" 37 Checked cartridge weight 0 Ccr F 17 Piping/conduit securety bracketed Last test& Repl.x_ 18 Nozzles cleaned 38 Grease accumulation o€mel Heavy 19 Proper nozzle caps/covers in place 39 Fusible Links 360 degree 450 degree_ 20 Proper clearance flame to filters 500 degtee_ other 21 Proper separa" n between fryers and flame 40 Fire extinguishers last insp.by:�-Data Ofyi_ THIS SYSTEM PASSED 0 NON-COMPLIANT (Vote: Improperly maintained exhaust systems and/or non compliant fire systems may fail to suppress a fare. Non-Compliance: For non-compliant systems,please caH 603-293-7531 and ask for the Systems Manager, or we will contact you within 5 busines ys. Cooking Appliances left to light: 4"r� ®13L"� CAie✓v4 Ti j�s�'ue¢, �P,LB t /9f i ael� Ad- - - - - -