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�%y��� I G--( G -G7 , <br /> CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT � <br /> o�v�,�� _�� (� �_����R�I <br /> Job Address �-I�11� �_�� I t C.J � permi; No. N► n7o9-v� � <br /> The refrigerant line natural LP/ medical gas system (circle one) was tested at �(� psi for a <br /> total of �_ minutes. <br /> WITNESSED BY ,.,,-�..1� ' (': � , �L Date � Z�- C� <br /> i ure o occUpar�t� est ig gzs service <br /> INSTALLED BY � � �1�' Date c �� ��.� <br /> —� � <br /> _ fTi5St3tti i � � , <br /> � <br /> Please arrange (or someone to be present on the date of requested inspection to provide access for <br /> ihe inspection. <br /> fiCFRIGERANT CONTMNING PARTS OF THE SYSTEM THAT IS FlELD ERECTED SHALL 6[TESTED FOR LEAK AT TEST PRESSURES NOT <br /> L.L55 THAN THE LOWER UF THE DESIGN PRESSUFiES OR THF SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> f-(�R TF_STI;JG SHALL BE THOSE LISTED ON TH[CON�ENSING UNIT OR COIdPRESSOR UNIT NAIdEPLATE.(WAC 57-42-1108) <br /> Hard Copy-Job Site Pink Copy- Contractor White Copy- Inspector <br />