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/ <br /> � G`� CITY OF EVERETT <br /> �� PIPING TEST AFFIDAVIT <br /> Owner J' ��E �t,�r <br /> Job Address 11..� � �`'''� a"'� S E Permit Na C- 4�T� Z ` G/ �I <br /> The refrigerant line / natural LP medical gas system (circle one) was tested at � psi for a <br /> i <br /> total of I�_ minutes. <br /> WITNESSED BY L Date �,3�uZ <br /> nature o occupant re �esting g� service <br /> INSTALLED BY Date �— 3 "� Z <br /> � <br /> Please arrange for someone +0 5e present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGERANT CONTAINING PARTS Oh TnE SYSTEM THAT IS FIELD ERECTED SIIALL BE TESTED FOR LEAK AT�EST PRESSURES NOT <br /> FOR TEST NG SHAOLL BE T�HOSE LDISTE C.N THE_1(,.E"D�NSING UN T IOR COMPRESSOR UN T NAMEPLATE.(WAC 5E D2 S;G�B PRESSURE <br /> Hard Copy—Job Site Pink Copy—Contractor White Copy—Inspector <br />