Report ` �; 3 vf' 6 � 9",,, Y" 1 HT1NG EQUIPMENT
INDUSTRIAL FIRST AID
D S a
_ PRESSURE WASHING
3357 SE 21st Avenue
i O X V 1 11 C , Portland. OR 97202
v (503) 232 -6646 FAX (503) 232 -7198
i. FIRE SYSTEM TEST & INSPECTION REPORT
i .,
NAME: rl ° IeuAU>5 PHONE
•
7 2 4- v E. T �A� R .
ADDRESS: /120 Sk' � E }� � Q zi p 47223
, SYSTEM' MFG MODEL SIZE LOCATION
SYS 1 NSu 1 3T‘L. k Teti EIQ
SYS 2 IusU L 1216%2 -- 3 K i a•I EN
S.YS3 QN3Ut K IOZ- 3,At. Ki`rCHEM
SYS 4
SY,# 1 SYS #2 SYS3 SYS #4
! 1. PIPING & CONDUIT SECURE. ✓ V
• 2. CHECK .SYSi EM FOR RUST/CORROSION ✓ f
I 3. NOZZLE" LCCAT1ON & APPL COVERAGE v f 1/
4. FUEL SHUT DOWN GAS.& ELECT sr
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5. OPERATION FROM TERMINAL UNIT f v ■ r
6. OPERATION FROM REMOTE PULL ` `�
7. FUSIBLE UNKS RE ?LACED V V
8. ALL NOZZLES FRE= OF OBSTRUCTION
9. ALL NOELES SEALED
10. HYDROTEST DATE i."/ G
11. CARTRIDGE RE?LACEMENT DATE
12. REGULATOR TEST DATE
13. ALARMS OPERATED PROPERLY %A a /k d�
14. PORTABLE E(T. PROPER TYPE & LOC ✓ ✓
15. SYSTEM MEETS CITY & STATE CODE V b 16. MGR & COOKS INST.. ON SYSI. OPERATION r ' J/
COMENTS:
TECHNICIAN SIGNATURE • (- ' DA TE ID 07
/ have read and reviewed this report with the technician providing this service. /
understand the report and have'received a copy.
OWNER/MANAGER