*** Inspection *** Please identify yourself as a Cintas representative when arriving onsite.

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1 Tech Clock-In/Out IVR: Job #: Tech ID #: 2902 FP Service Instructions Job #: *** Inspection *** You must clock in and out of this job through Cintas's IVR phone system! Call (toll free) from any phone Enter job number: then press # Enter technician ID number: 2902 then press # ***FOR ONSITE APPROVALS*** DAYTIME (8AM-5PM Eastern): AFTERHOURS (5PM-8AM Eastern): *** Clock in when you arrive on site *** Clock out when you leave *** Please identify yourself as a Cintas representative when arriving onsite. Perform the following services and inspections: Inspect 2 Tank Semi Annual Maintenance Special information: ALL JOBS MUST REFLECT TECHNICIAN ARRIVAL AND DEPARTURE TIME ON PAPERWORK FOR JOB PROCESSING AND PAYMENT Customer purchase order: YOU MUST IMMEDIATELY NOTIFY CINTAS OF ANY RED TAGGED SYSTEMS! FOR SUPPRESSION JOBS ONLY: Please complete a Range Hood Systems Report (RHSR) for every suppression system at this location. FOR ALL JOBS: You may service the systems you are inspecting up to the Not To Exceed (NTE) limits shown above. Complete the Job Actions/Parts list to reflect all services performed and parts used during this inspection. Use your extinguisher, emergency/exit light, and sprinkler/backflow inspection forms where required by local law. Leave one copy of each form on site and fax the other copy back to Cintas. DO NOT leave this instruction sheet on site.

2 Tech Clock-In/Out IVR: Job #: Tech ID #: 2902 Range Hood Systems Report Job #: System Inspected: 2 Tank Semi Annual Maintenance Time Started: am / pm Time Finished: am / pm Inspection Recharge Installation Other Location of System Cylinders: Manufacturer: Model: Cylinder Size (Master): gal Cylinder Size (Slave): gal Cylinder Size (Slave): gal Cylinder Size (Slave): gal Fuse Links: qty 360ºF qty 500ºF qty other Fuel Shut Off: Electric Gas Size: Last Hydro Test Date: Fire Alarm Present? Yes No Sprinkler System Present? Yes No # Nozzles: Number and Size of Duct(s): Hood Size & Plenum Size: Cooking Appliance Locations: Left to Right All appliances properly covered w/ correct nozzles 19. Check travel of cable nuts/s-hooks 2. Duct and plenum covered w/ correct nozzles 20. Piping and conduit securely bracketed 3. Check positioning of all nozzles 21. Proper separation between fryers and flame 4. System installed in accordance w/ Mfg UL listing 22. Proper clearance - flame to filters 5. Hood/duct penetrations sealed w/ weld or UL device 23. Exhaust fan operating properly 6. Check if seals are intact 24. All filters reinstalled 7. If system has been discharged, report same 25. Fuel shut-off in ON position 8. Pressure gauge in proper range (if gauged) 26. Manual and remote set/seals in place 9. Check cartridge weight (replace, if needed) 27. Replace systems covers 10. Demonstrated detection line activation for MOD 28. System operational and seals in place 11. Inspect cylinder and mount 29. Slave system operational 12. Operate system from terminal link 30. Clean cylinder and mount 13. Test for proper operation from remote 31. Fan warning sign on hood 14. Check operation of micro switch 32. Personnel instructed in manual operation of system 15. Check operation of gas valve 33. Proper hand portable extinguishers (K and ABC) 16. Nozzles clean and free of debris 34. Portable extinguishers properly serviced 17. Proper nozzle covers in place 35. Service and certification tag on system 18. Replaced fuse links (record date here) 36. UL 300 compliant Note Discrepancies or Deficiencies: SYSTEM COMPLIANT? COMPLIANT NON-COMPLIANT SYSTEM RED TAGGED? YES NO SYSTEM HAS DEFICIENCIES? YES NO Red tags must be called in to Cintas at immediately Technician Signature: Cert. #: Date: My signature and certification number indicate that I have personally completed this inspection and found conditions as indicated on this report. I have demonstrated the detection line activation for the Manager on Duty. Customer Signature: My signature indicates that I have reviewed and approved all work done by this technician, and am satisfied with the work and the final condition of my facility. I was offered to witness the detection line activation. Title: A Cintas authorized technician has completed your life safety inspections per local code, NFPA guidelines and manufacturers requirements. Safe operation of your equipment is the responsibility of the facility owner or their agent. You are responsible for ensuring that any corrections and repairs to your life safety systems are completed. Cintas will provide a formal quotation to complete the required repair to bring the life safety systems back into compliance. Cintas does not assume any liability for the condition of your life safety systems and is acting as an advisor on the working condition, performance potential and code compliance of your life safety systems. NFPA17A Chapter 7 paragraph states the following: Where the maintenance of the system(s) reveals defective parts that could cause the impairment or failure of the proper operation of the system(s), the affected parts shall be replaced or repaired in accordance with the manufacturer.s recommendations. Until such repairs are accomplished the systems shall be tagged as noncompliant and the owner or owner.s representative responsible for the system and the authority having justification shall be notified. Unless you specifically authorize Cintas to perform the necessary repairs, any deficiencies, impairments or required repairs discovered as a result of our inspections are not the responsibility of Cintas.

3 Fire Protection Deficiency Reporting Policies Please be aware that all job types (whether Inspection, Service Call or Repair) require full IVR compliance to qualify for payment. Deficiency reporting, notifications and proposals are some of the most important aspects of our fire protection program. With that, we ask that you give this area of service the utmost attention. In regard to inspections or service calls that result in a reported deficiency by your technician: Photo validation of said deficiency is mandatory. Therefore, make every effort to photo validate while on site! Photo Validation Standards: o Note: EVERY sprinkler head reported as deficient MUST be photo documented to qualify for proposal approval Sprinkler Gauges out of date Upclose picture of gauge with date shown. Sprinkler Leaking Pipe / valves/ connections (Wet System) Picture of any leak/water on the ground Sprinkler FDC Caps missing Picture of FDC without caps Sprinkler Sprinkler coverage needed (additional heads) Picture of area without coverage Sprinkler Recalled/expired heads Upclose picture of heads with markings/dates Sprinkler Missing spare head box, heads, or wrenches Picture of box (if present) open to show missing items. Sprinkler Raise/lower heads to correct height Example of head not at correct height. Sprinkler Corroded sprinkler heads & pipe Picture of ALL corroded head/pipe. Sprinkler Missing escutcheon plates Picture of ALL sprinkler heads with missing plates Sprinkler Missing Signs Pics of areas that should have signage Sprinkler FDC needs flush Picture of debris in FDC Sprinkler Tampers not secured Picture of unsecured tampers Sprinkler Sprinkler head obstruction Picture of obstruction & head Sprinkler Painted sprinkler heads / plates Picture of ALL painted items Sprinkler Inspectors test valve not piped / cannot full flow test Picture of Inspectors test valve /drains if applicable Alarm Troubleshooting Alarm Panels / devices Picture of message on panel Alarm Replace broken devices Picture of existing device(s) Alarm Remount devices Picture of hanging/improperly mounted devices Alarm Devices out of date Picture of date stamp on device Alarm Water damaged / corroded devices Picture of devices Alarm Batteries out date Picture of date stamp on device Alarm Switches/devices not wired in Picture of devices Alarm Area without proper device present (i.e. pull stations) Picture of area Alarm Missing rods in pull stations Picture of pull station Alarm Broken covers for devices Picture of broken cover Kitchen Systems Hydrostatic Testing Due Picture of date stamp on cylinder Kitchen Systems Additional coverage / improper coverage needed Picture of area without coverage Kitchen Systems Replace detection line due to grease build-up Picture of detection line Kitchen Systems Replace nozzles due to build-up Picture of clogged nozzles Emergency Lighting Damaged units Picture of damaged units System Deficiency Notes for Pictures Extinguisher Areas without extinguishers (i.e. kitchens w/o K class) Picture of area Extinguisher Damaged/corroded units Picture of device Again, IVR is mandatory in order for the deficiency to be properly logged Upon reporting a deficiency, you will receive a proposal request from our system o If the requested date on the proposal request is NOT met, the original inspection you performed is subject to reschedule & redo, cancellation and/or reassignment

4 Tech Clock-In/Out IVR: Job #: Tech ID #: 2902 Job Actions/Parts List Job #: FIRE EXTINGUISHER INSPECTION/SERVICE Fire extinguisher inspection (service details below) Fire Extinguisher Sign Fire extinguisher hung/relocated Labor Rate (Portable Extinguishers) Chemical - per lb. (ABC/BC) Chemical - per lb. (CO2) Chemical - per Unit (K Class) Additional 9 Volt Battery Extinguisher Tamper Seal Extinguisher O-ring Extinguisher Valve Stem (All) Extinguisher Pull Pin CO2 Extinguisher Safety Disc and Washer CO2 Extinguisher Hose Continuity Test 5 lb. Dry Chemical Extinguisher Discharge Hose 10 lb. Dry Chemical Extinguisher Discharge Hose Extinguisher Decals (Class, Health, UN, UL, DOT, HMI Extinguisher Gauge Extinguisher Verification Collar Extinguisher Mounting Hook Extinguisher Universal Wall Bracket Extinguisher Upper Handle Extinguisher Siphon Tube Extinguisher Hose Strap Nevada Annual Tear Down Mounting Bracket (includes install) KITCHEN/SUPPRESSION SYSTEM LABOR & MATERIAL Semi-annual maintenance Hydrotest system cylinder & recharge (qty tanks) Fusible Link, 360 deg Fusible Link, 500 deg Fusible Link, Other Blow-Off Cap, Rubber Blow-Off Cap, Metal Nozzle Seal Nozzle Replacement Cartridge, R101-20, Ansul Cartridge, R101-30, Ansul Cartridge, LTA , Ansul Cartridge, R102 Dbl Tank, Ansul Cartridge, PyroChem Hood Caution Sign Pull Station, Break Rod System flush (qty tanks) Labor Rate (Fire Suppression) Pick-up tube o-ring Pyrochem Cartridge o-ring Nozzle cleaning labor Fusible Link, 450 deg Cartridge - 12 gram Cartridge - 16 gram Cartridge - LT - 10R Ansulex 3 gal Clean Room Door Fan Test (room integrity) Clean Agent After-Hours Test (4 hr max of EPO, equip Clean Agent Puff Test per Hazard CO2 High Pressure Hydrostatic Testing and Recharge S CO2 High Pressure Inspection Additional Cylinder (in Hydrotest, Self-Contained Breathing Apparatus EMERGENCY LIGHTING INSPECTION/SERVICE Inspect emergency/exit light Emergency Light Bulb - AC Battery Bulbs, LED NiCAD Battery New, Emergency Light New, Emergency/Exit Combination Unit Labor Rate (Emergency / Exit Lights) New, Exit Sign 90 Minute Burn Test Battery, 6V 4AH Battery, 6V 7AH Battery, 6V 10AH Battery, 6V 12AH Battery, 1.2V 1200 ma NiCAD w/lead E-Light Bulbs 13-14V, 15W E-Light Bulbs 120V, 20W Exit Light LED Bulbs, T-6 Battery, 6V 5 AH

5 FIRE EXTINGUISHER INSPECTION AND SERVICE - DETAILS HYDRO & 6 YEAR Enter quantity for each INSPECT RECHARGE RECHARGE MAINT NEW Dry chemical 2.5lb Dry chemical 5lb Dry chemical 10lb Dry chemical 20lb CO2 5lb CO2 10lb CO2 15lb CO2 20lb Water 2.5 gal K Class FE-36 QTY OTHER/MISC PARTS DESCRIPTION Comments: Technician Signature: Date: My signature and certification number indicate that I have personally completed this inspection and supplied the parts indicated above. Customer Signature: Date: My signature indicates that I have reviewed and approved all work done by this technician, and am satisfied with the work and the final condition of my facility. STORE STAMP A Cintas authorized technician has completed your life safety inspections per local code, NFPA guidelines and manufacturers requirements. Safe operation of your equipment is the responsibility of the facility owner or their agent. You are responsible for ensuring that any corrections and repairs to your life safety systems are completed. Cintas will provide a formal quotation to complete the required repair to bring the life safety systems back into compliance. Cintas does not assume any liability for the condition of your life safety systems and is acting as an advisor on the working condition, performance potential and code compliance of your life safety systems. NFPA17A Chapter 7 paragraph states the following: Where the maintenance of the system(s) reveals defective parts that could cause the impairment or failure of the proper operation of the system(s), the affected parts shall be replaced or repaired in accordance with the manufacturer.s recommendations. Until such repairs are accomplished the systems shall be tagged as noncompliant and the owner or owner.s representative responsible for the system and the authority having justification shall be notified. Unless you specifically authorize Cintas to perform the necessary repairs, any deficiencies, impairments or required repairs discovered as a result of our inspections are not the responsibility of Cintas.