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Owner <br />Job Addr <br />CITY OF EVERETT <br />PIPING TEST AFFIDAVIT <br />The refrigerant line / natural / LP / medical gas system (circle one) was tested at �psi for a <br />total of ��minutes. p� <br />WITNESSED BY �- f� Date b�2'Y`�Uj <br />i wre occu ant requesting gas serwce <br />INSTALLED BY Date Sf��?f/'�� <br />��'�.,,��� � <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINING PAFTS OF THE SYSTEM THAT IS FIELD ERECTED SHAIL 8E TESTED FOR LEAK AT TEST PRESSURES NOT <br />FORS EST NG SHAOL,L BE TOHOSE LDISTED ON THE CONDE�NSING UNIT IOR COOMPRESSOR UN T NAMEPLATE. (WAC SE D2 S�Oe PRESSURE <br />I�ard Copy — Job Site Pink Gopy — Contractor White Copy — Inspector <br />