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�. <br />Owner — <br />Job Address <br />CITY CrF EVERETT <br />PIPING TEST AFFIDAVIT <br />!'��i� PermitNo. r'"�J.-_���`�l <br />The refrigerant line / natural / LP / medical ga� system (circle one) was tested at 1� -Psi for a <br />total of �_ <br />WITNESSED BY <br />INSTALLED BY <br />Date � l J l/ <br />Date / 6 <br />Please arrange for someone to be present on the date of requested inspeciion to provir�e access for <br />the inspection. <br />'r�EFRIGERANT CONTAINING PARTS OF THE SYSTEM1i THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br />FOfl EST NG SHAOLL'B[ T�HOS[ LDISTED ON TEhSE CONDENSING UN TIOR COOMPRESSOR UN T NAMEPLA EC(�`S/AC SE D2 S�08� PRESSURE <br />Hard Copy – Job Site Pink Gopy – Contractor Whi;e Copy – Inspector <br />