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� CITY OF EVERETT <br /> PIPING TEST AF�IDAVIT <br /> Owner �� �7 '1 � , `, <br /> Job Address � b/ (�• 5 �i`� U�� C '� Permit No. L` �/�] —o o� <br /> � <br /> The �afrigera ine / natural / LP / medical gas system (circle one) was tested at �_psi for a <br /> total oi � minutes. <br /> WITNESSEDBY� � �� �U( Date <br /> ig tu e o occu. p�nt requesung gas service <br /> INSTALLED BY __�� r�. Date ��/y—p� <br /> � z�ttrsaraYti��gas � <br /> Please arrange tor someone to be present on the date of requested inspection to provide access for <br /> the inspection. <br /> REFRIGEPANT CONTAINING PARTS OF THE SYSTEh1 THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> LESS THAN THE LOWER OF THE DESIGN PRFSSURES OR THE SETTING OF THE PRESSURE REI.IEF DEVICES. THE DESIGN PRESSURE <br /> FOR TESTING SHALL OE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNI!NAMEPLATE.(WAC 5 i-42•1108) <br /> r Hard Copy—Job Site Pink Copy— Contractor White Copy—Inspector <br />