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Ar,lima <br />HVAC - Sheetmetal - Plumbing <br />m Dl,a9-C)0a <br />GAS PIPING TEST AFFIDAVIT <br />OWNER (PLEASE PRINT) �w0 <br />ADDRESS <br />l.J. <br />k-7L <br />MANUFACTURFR OF HOME (IF KNOWN) NIA <br />SERIAL NUMBER OF HOME (IF KNOWN) t4JA- <br />I, i�4Ct N�t �, CA�- am authorized to certify on behalf <br />of SL,I (?n` that on <br />(Company Name) <br />.5a.a4• 205Y the gas piping system was tested as follows: <br />(Date) <br />1. Before all appliances were connected, at three (3) PSI for a period of not less than ten (10) minutes without <br />showing any drop in pressure; and <br />2. After the appliances were connected and the system was pressurized to not less than ten (IQ) inches nor more <br />than fourteen (14) Inches water column and the appliance connections were tested for leakage with soapy water <br />or bubble solution, no leaks were observed. <br />SIGNATURE OF STER <br />OTHER W1TNESS SIGNATUR ) [WHENAVAILABLE]: <br />OWNER OR CONTRA OR <br />GAS COMPANY <br />INSPECTOR <br />