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0�,:�ncr ---- <br />,;ob Address __ _ <br />�.:�-r� c�� EVERE-rr <br />F'IPIf��, TEST AFFIDAVIT <br />�.., ;�.�: � <br />Permit No. _ <br />Thc re(riyerant lin� / natural r' LP i m�dical gas system (circle one) was tested at _psi for a <br />total of _ minutes. <br />WITNESSED BY Date <br />ignature o�occupani reyuesuny gas service <br />INSTAI_LED BY Date <br />--iSG�tl�luf�'��i'�iil`l�iIIiilij y3:`(i(G;ij <br />; � : <br />Pleasu �irran��e for �omron� to he present on the date oi requested inspection to provide access for <br />the inspection. <br />��.; I HI�ERANT CONTAINING PAFiTS OF THE SYSTE61 THAT IS FIELD ERECTED SHALL BE TESTEG FOR LEAK AT TEST PfiESSURES NOT <br />.r; THAN THE LOW ER UF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE REUEF DEVICES. THE OESIGN PRESSU(:L <br />.���. iESTING SHALL BF. THGSE LISTED ON THE CONDENSIIJG UNIT OR COh1PRESSOR UNIT NAMEPIATE. (WAC 51�42-11081 <br />".� I-lard Copy - Job Site Pink Copy - Contractor White Copy - Inspector <br />r-` <br />