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CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner � ��'`'` � �'-�� __ -- q <br /> Job Address '���G Permit No. .� �y� I ' �/ <br /> The re(rigerant line / atural LP / medical gas system (circle one) was tested at ��7 psi for a <br /> total o( �_ minutes. <br /> WITNESSED BY �_ �� Date � • Z`1 ' � y <br /> ignature o occu ant request�ng gas serwce) <br /> INSTALLED BY ����� � r� r.r� Date �• Z� <br /> ar-�rrst3trt � as�tttei�� <br /> Please arrange for someone to be present on the date of requesled inspection to provide access for <br /> the inspection. <br /> FEFRIGERAtJT CONTAINING PARTS OF TN[SVSTGRt THAi IS FIELD[R[CT[D SHALL B[TESTED FOR LEAK AT TEST PRESSURES NOT <br /> 1E55 THAN THE LOWER OF THE DESIGN Pf�[SSURGS Of� TM[ SET-TING OP THE PRESSURE REUEF UEVICES. THE DESIGN PFESSUF7E <br /> FOR TESTING SHALL BE THOSE USTED OIJ TNE CONDENSWG UNIT OF COMPq[SSOR UNIT NA'dEPLATE (1NAC S1�a2�1100) <br /> Hard Copy — Job Sit? Pink Copy — Contractor White Copy — Inspector <br />