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Owner ���' <br />Job Address _ <br />CITY OF EVERLTT <br />PIPING TEST A�FIDAVIT <br />C� <br />1 •�� <br />`- �� ►. s..: 11 ._I • <br />/ <br />The refrigerar Jine natural� LP / medical gas system (circle one) was tested at 1�_psi for a <br />total of ��_ minuies. ._ � <br />" � : , � �— Date -� ' •�� <br />WITNESSEDBY �` '�"�`'- /�J <br />��nature o�'occupant r questing gas serwce 1� /'� <br />INSTALLED BY �,� � � r�,� 1l�,-�/,-� ' Date <br />i u i�� <br />Please arrange for someor�e to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFHIGERANT CONTAINING PARTS OF l'HE SYSTEM1t THAT IS FIEID ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PFESSURES OR THE SETTING UF THE PRESSURE RELIEF �EVICES. THE DESIGN PRESSURE <br />FOR TESTING SHAL_ BE THOSE LISTED ON THE CONDENSING UNIT OR COh7PRESSOR UNIT NAMEPLATE. (WAC 51•42•1108) .-/ \.. <br />Hard Cupy - Job Site Pink Copy - Contractor White Copy - Inspzctor 1� 4 <br />