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Complete Line of Quality Firefighting Equipment
4025 E Commercial WAY SE Suite B
'4L PO Box 1556 Albany, OR 97321
COS#100355
541-9264920 Fax 541-9264942
Kitchen Hood Suppression System installation Certification
Permit# f P S ootisq
Date: Z et-t
Bashess Name: 11
Address: V
installer Representative: 11/11 1---e,-5,A.5 0
Installer Telephone Number: vT, -
Type of System: An5 R--107
Location d Plans: c -vsk
Location.of Owneis Minuet: 0 fâ k
1. Certification of System Installation: Complete this section after system is installed,but
prior to tonducOng operational acceptance tests. This system installation was inspected and
was found to comply with the installation requirements of:
NFPA 13 and 96
UFC
Manufacture's Instructions
Other(FM, UL, etc.)
Print Name: /1/110/1."2
Signed: NYviei Date:_3-2
Organization: Y
2. Certification of System Operation:All operational features and functions of this sot=
were tested and found to be operating properly in accordance,with the requirements of:
NFPA 13 and 96
UFC irt
tvientoftewra's instradions
Other(FM, UL, etc.)
Print Name: iv hi,4)c,I 1-civ,Dc/..
Signed: (3,p41/1.__F --
Organization: \14-(6,1 Date â (a.