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{�HgUSE�( HEATING TEST RECORD <br /> t Jv pGeO <br /> ADDRESS APT. FLOOR CITY SUBURB <br /> OCCUPANT ^K�� ✓ �'rh OWNER <br /> HEAT LOSS DATE HTG. INST. I4-/O —"j'{ <br /> �SQ6&-Sl` ��ti-, FYIri'FZ 14e INSTALLED BY <br /> Electrical Work By Gas Line By <br /> TYPE OF HEAT GA FA,[,�g_HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> LGAS DESIGN CONVERSION <br /> MAKE C 43 Q IN MAKE OF BURNER <br /> Model 54-90(_ Model <br /> Serial Max. BTU Rating <br /> INPUT � � �T� MAKE OF FURNACE <br /> Model <br /> CONTROLS ! ' <br /> THERMOSTAT Heat Plug Vent Size y <br /> Valve •..KIND OF LINER L SIZE NONE <br /> Limit Draft Hood h 1�4^ P Reguloior <br /> Limit Setting fi� �� Filters Size Number <br /> Fon Setting Chimney Location 13(19(z- <br /> Pilot <br /> Outside <br /> Type Chimney Construction 13( <br /> Pilot T oG✓ Sd^ C��^��b C �n 0f <br /> � <br /> Pilot Make <br /> Pilot Model Smoke Bomb Wiring <br /> Pilot Timing Droft Test Tog <br /> L.W. Cut Off Door Pressure Lighting Inst. <br /> Pressure Percent CO2 Dote Tested �,� <br /> �� Company Testing X77 �✓ L' <br /> Input CFH Percent 02 � <br /> Stack Temp. ' 2iz 25 ' ' Percent CO b Nome of Tester <br /> Form 235 r'. . <br />