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, <br />Owner <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />-e � �7% �.` <br />Job Address 2 � � � ��D l� �C � �� <br />�1�� � �a� � <br />ifTll� �O. � <br />The refrigerant line / t k� � LP / medical gas system (circle one) was tested at �'`� <br />total of �� minutes. <br />WITNESSED BY <br />Date <br />(Signature of pant requesting,gas service) <br />�..--~'"'� .w...---�� � p � �/ �,/ <br />INSTALLED BY (1l'�� Date < � f� <br />�. ° -- - <br />(Signature of installing gas fitter) <br />psi for a <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 SETT"ING 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 />