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_.__.----------- - -------- --- -_._. ,_._.�..__._.._._ �-_____,�:... �.,:_� <br /> WASHINGTON ENERGY SERVICES <br /> Customer Assurance / Gas Piping Test ,Aifidavit <br /> Homeowner (or representative) K^"'"� bf�Ac���c� <br /> Address -"1�c .�n�c 5�-- Permit No. <br /> The gas piping system was tasted at �� psi fur a total of �.?� minutes. I' <br /> Wh _ Range �� <br /> Isolation Valve Location We Instelled: Fu �pryer <br /> 1 <br /> Fpl �`nit Hir _ <br /> Boller _ Other__ <br /> WITNESSED BY �/ /G /�4 <br /> (aignetu oi o owner or euthorize representetive ate � <br /> _ INSTAI.LED BY 7'��^ �'�t- � ,, c� <br />, .�—� ' (c ��- <br /> —(inst�� please print name ete <br /> This af(idavit does not take the place of a gas piping inspectioin performed by an inspector from your <br /> �.�urisdiction. This affidavit is for the use oi Washington Energy Services only. <br /> >� . <br /> . <br /> I Mroo. vz�,'ee WM11E COFV•OFFICE �FLLOW COPV-JOB SITE(UPE TO EOVIiiIENTj <br /> Lk.No.WASNIES07i0J <br />