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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT � <br /> Owner �'h t�-� ��C—� <br /> Job Address �g 19��'�L�-�l__� �11� Permit No. �0�j " �Dv� <br /> The reirigerant line / natural/ LP / medical gas system (circle one) was tested at 3�� psi for a <br /> total of �aD � minutes. <br /> WITNESSED BY Date <br /> ignat re o p t reyuesting gas service <br /> INSTALLED BY � Date �j O <br /> i i g§3S-'Tilt <br /> Please arranye ior someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAINI�iG PARTS UF TH[SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PAESSURES NOT <br /> LESS THAN THE LOWER 11F TH[D[SIGN PR[SSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOR T[STING SHALL 8E THOS[LIST[D ON TI1E CON�ENSIIJG UNIT OR COh1PRESSOR UNIT NAMEPLATE.(WAC 51-d2-1108) <br /> � Hard Cop• •,Job Si?e%� Pink Copy–Contractor White Copy– Inspector <br />