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`�f� ' <br />Owner <br />CITY OF �VERETT <br />PIF�ING TEST AFFIDAVIT <br />Job Address �� (n 3��' .� -'L� f� J t� Permit No. �Ji � 7ld d'`f!i <br />The refrigerant line / natural LP / medical gas system (circle one) was tested at �_psi for a <br />total of � minutes. <br />WITNESSED BY ' <br />� igna ure o occupant equesting gas serwce <br />IPJSTALLED BY <br />—��t� � as � <br />Date <br />Date <br />�-/ 5 �� <br />��- IJ•U7 <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />ihe inspection. <br />REFRIG[R/,�1T CONTAINING PARTS OF THE SYSTEh1 THAT IS FIELD L"RECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />L[55 THqN',1E LOIVEfi OF TH[ DESIGN PRESSURES OFi THE SET7ING OF THE PRESSURE RELIEP DEVICES. THE DESIGN PRESSURE <br />FOR f[STING SHALL �E THOSE LISTEU ON THE COND[NSING UNIT OR COh1PRE5SOR UNIT NAMEPIATE. (WAC 51•42�1108) <br />Hard Copy - Job Site Pink Copy - Coniractor White Copy - Inspector <br />