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grrCITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner CO / L 0 <br /> Job Address / D 6/6 /77 i1—'" sem= Permit No ( 16'® <br /> .006( <br /> The refrigerant line / natural / LP I medical gas system (circle one) was tested at 3c psi for a <br /> total of 600 mi utes. <br /> WITNESSED BY \LQ_,6 h. <br /> 11' t —EC—CI-EC-CIDate 1 Et <br /> (Signature of occupant requesting gas service) <br /> INSTALLED BY `"- Date / 2-Y / 9 <br /> ignature nstalling gas fitter) <br /> Please arrange for someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAINING PARTS OF THE SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAKS AT TEST PRESSURES NOT <br /> LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES.THE DESIGN PRESSURE <br /> FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAME PLATE.(WAC 51-42-1108) <br /> Hard Copy -Job Site Pink Copy - Contractor White Copy - Inspector <br /> PWPTA(5/17) <br />