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��� <br />CITY OF EVERETT <br />plPihu TEST AFFIDAVIT <br />�J I I <br />O�vner '--_l�Ja��ll_ �� --- — ��� <br />Job Aciciress _�._�.�..Q��tcJ_ �l%� Perm�t No.i���n/� - �"L <br />The �efriger.in� line natur LP / medical gas system (circle one) was tested at <br />��� tes <br />total of _ minu � . <br />�,NITNESSED BY <br />IfJ�iTALLED BY <br />�psi ior a <br />Dale � - 7 `-�1 <br />Date � p <br />Ple�ise air3ngc for someon� to be present on the da�s of requested inspection to provide access for <br />(l;c inspection. <br />iiLl� NIGERANT CONTAIMING PARTS OF THE SVSTEM THAT IS FIELD ERECTED SHALL BE TESTED POR L[AK AT TEST PRESSURES NOT <br />i.LS>I 7IL�N THE LOWEH Of- 1 HE UL-SIGN I'HESSURES OR THE SET1lNG OF THE PRESSURE RFLIEF DEVICES. TH[ DESIGN PRESSURE <br />I-Ui; � E-.STIFJG SHALL �E THOSf LISTED ON THE CONDENSING UNIT OR COhiPR[SSOR UNIT NAhiEPLAI E. IIVAC 51-12�11081 <br />Fiard l;opy -Job Slte <br />Pink Copy - Contractor White Copy - Inspector <br />