FDNY Inspection Order form, July 1994

NYC 9/11 Public Portal Document

RANGEHOOD UNIT INSPECTION REPORT Inspection Date: I I I Account No. 2^61£7/j11 Folder No. Restaurant Name: _______

Premise Address: u/-rc Boro: Zip; J ssssss ssssssssssssss = ssssss = s:sssss:s = ss = S = = SSSSS:S = BS8SSSS3SSSSSBSSSSSSSSB8SSSSS

Name of System: Model No. /Ziei No. of Cylinders; Gals./Lbs.

System Approved? Yes Q No F.D. Tag No. LLm Type of Inspection; 106 Initial Q1 Reinspection

With Plans; I.O.C.: pS Referral: V.O. No.: Installation Conforms to Tag/Plans? Yes Q No V.O.(s) Issued: RH Code;

asSS = SSSSS = SSS = SSSS& = BSSSS = = SSS = &BSSSSSSSSS; = SB

Approved Filters? No Quarterly Cleaning? Yes □ No Semi Annual Service By Authorized Contractor? Yes □ No Sketch / Cleaning & Operating Insructions? Yes □ No N.O.V.(s) Issued; No.(s) _________________________________________________________________ = =:=:=:z: = = =:=: = = = = a: = =: = =i = = = = = = = = = i= = = = = = = = = = «= = = = = = = ‘= = = = = = =' = *' = = = = = = = » = = = = = = = = = = = = = =

Comments: Ay ■ ■S lX/~7 ~72?

1)

Print Inspector's Name

-- sign Inspecdr's Mame

RHINSP (11/90)

NYC-WTC_000166086