Prestige Care Rosemont 337428 HD INSP REP 11032015RT
& i Hood and Duct Services, Inc.
6100 12th Ave. S. Phone (206) 726-0940
Seattle, WA 98108 Fax (206) 767-2607
COMPLETE Certification Given: RED E] YELLOW❑ WHITE!_:!'-
FIRE PROTECTION CONFIDENCE TESTING RANGEHOOD
High Pressure Hood Cleaning SYSTEM TE T REPORT
• Fire Suppression Installation & Service CONFIDENCE TEST Z REPAIRS El
• Fire Extinguisher Sales & Service
Range Hood and Fan Service & Repair
• Filter Sales & Service DATE:
Occupancy Name: _ 3 " 9 P l�Arl r L• Tyr__
.
Occupancy Address: Z.15 _ k_; U i
Responsible Person: r
Building Owner:
Building Owner Address:
Testers Name (Please Print): --y a5_j.
City, State, Zip:
Phone Number:
Phone Number:
City, State, Zip:
SFD Certification Number:
System Alarm? Yes 2—No ❑ Central station monitoring? Yes R No ❑
Monitoring company name:
Control Panel manutaxll rer. Model Number
y�
Location of Alarm Panel. CC I 14 Ar„ I
Extinguishing System Manufacturer d % "o I Syste/m� Size 3 y� � U 300 System? Yes �o❑ U.L. 300 Compllant? Yes [❑ Chemical Type: Wet Z/ Dry❑
Location I Height of Range hood:
€s pressure ganga indicator In operable range?
12 year hydra date of cylinder. zoo �.
Is there chemical inside al the cylinder? Yes No.--
Were hand portable extinguishers property serviced? NA Yes. % No
Weigh CO2 of nibogen cartridge NA 'irk s Z
Were all cooking surfaces protected? If not, give owner full Yes + No
No visible signs 4f a systom fire or system tampering tit signs check no). Yes r No
Check all piping and conatrrl. Aro all piping and eondud Immobilized with Yes % Np
information.
Was operating procedure verbally given to restaurant personnel? Yes % No
proper hangers and brackets?
Was UL 3130 compliance explained to owner or manager'+ Yes No i
Ale all prolective covers present 4n nozzles? Yes No '
Gas shuts down upon system activation? NA Yes No
Are all rwzxI 5 shacked in the proper position? Yes : No
Electric power shuts down upon system activalion? NA Yes No
Does system have adequate volume and/or nozzle coverage? Yes No 1
Range hood tied to building alarm panel? NA / Yes, No
Are all appliances Inside of the hood protection areal Yos Nn
Range hood activation signal received at building alarm panel? NA -*"Yes No _
Have fuse links been replaced? Yrs NO--
Class K extinguisher present? Yes / No _
Was systom optimbonal from terminal Iink? Yes No
Was system operational irflm manual remote? Yes % No
Grease buildup in group:
Light oO—++ Medlum - . Heavy, recommend cleaning
Was system and muxo switch operational? NA Yes Nd
Date of last cleaning {--Q-/ 15 A-11 C-114 S h4& 4 up
Is system visible and free from obstruction) yes No _y
is the inspection and service bog on the cykndon Yes NU
Are cleaning intervals within NFPA standards? Yes No
Previous Confidence Test Company & Technician �. j a FF �t16r�-� west
i i✓
Problems Found: (If additional room is needed, please add a separate sheet)
Corrections Made: Date
Corrected By:
i♦ X A, y
36 36
>e
Gr, dd t RQ r).
Customer has declined repairs X
SFD Certification Number:
This certifies that this fire and life tamale y h r any r0dirlo
ad for reliability to cover the items listed in this report and is consistent with Seattle Fire Department Fire Code
standards. Discrepantaos r e re rte o ! OwnedResponsible Person far corrective action
Signature of Tester. Phone # __L0.1726 0940
-resting Agency: Hood and Duct Service Inc. Maillrtg Address: -0-% 12th Ave. S., Seattle. WA
The ciner is to perform and keep a written record of the following "quick check" fire system inspection to verify the following:
1. The extinguishing system is in Its proper location. The extinguishing cylinder Is in 6 The nozzle disc caps and their seals are intact, undamaged and light.
place and has not been removed or tampered with. 7. The Inspection tag or certificate is in place and current.
2. The manual pull stations are unobstructed and in clear view and are labeled for 0. It any deficiencies are found, appropriate corrective action shall be taken Immediately,
intended use. 9. A record of the monthly inspections is to be kept reflecting the date I cte mfiilals of
3. Insure that all tamper seals are intact and that system is in a ready condition, person performing thin inspectionref any corrosions rsc}�z
4. thaso rvet might
system, checking rhal no obvious physical damage or condition exists AUTHORIZED /
I That mlphl prevent Operation. J](L �,
5. The pressure gauge reading on tha eyllnder shall be rn 1he green operabfo range. SIGNATURE
FIRE DEPARTMENT COPY