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CITY OF EVERETT <br />PIPING TEST AFMDAVIT <br />Owner N r^ <br />CV- <br />Job Address L/ r4 kb �'L/ V , /( Permit No. <br />The refrigerant We / to / LP / medical gas system (circle one) was tested at psi for a <br />total of mi to"s. �— <br />WITNESSED BY CL. c— Date <br />gnature pf occ pan r uesting gas service <br />INSTALLED BY r 3�^ _ DateIulu LI 17Z <br />Please arrange for someone to be present on the date of requested inspection to provide access for <br />the inspection. <br />REFRIGERANT CONTAINING PARTS OF THE SYSTFN1 THAT IS FIELD ERECTED SHALL BE Tz3TED FOR LEAK AT TEST PRESSURES NOT <br />LESS THAN THE LOWER OF THE DESIGN PRESS�I as OR THE SETTING OF THE PRESSURE BELIEF DEVICES. THE DESIGN PRESSURE <br />FOR TESTING SHALL BE THOSE LISTED ON THE CJNDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE. (WAC 51-42-1108) <br />Hard Copy — Job Site Pink Copy — Contractor White Copy — Inspector <br />