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OL CITY OF EVERETT <br /> PIPING TEST AFFIDAVIT <br /> Owner Q2 jg t' d L M r <br /> Job Address 41 Z Z SE Permit No. 22 O <br /> The refrigeraa t line / natur ! medical gas system (circle one) was tested at _psi for a <br /> total of _ min4tes. <br /> WITNESSED BY l/l i a �� �s� ` ` A Date <br /> Igre o o cup t ques Ing gas service <br /> INSTALLED BY —% Date Ll- z <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 SYSTEM THAT IS FIELD ERECTED SHALL BE TESTED FOR LEAK AT TEST PRESSURES NOT <br /> LESS THAN THE LOWER OF THE DESIGN PRESSURES OR THE SETTING OF THE PRESSURE RELIEF DEVICES. THE DESIGN PRESSURE <br /> FOR TESTING SHALL BE THOSE LISTED ON THE CONDENSING UNIT OR COMPRESSOR UNIT NAMEPLATE.(WAC 51-42-11 1108) <br /> Hard Copy—Job Site Pink Copy—Contractor White Copy—Inspector <br />