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House Heating Test Record , <br /> Address �� i � �C.�,��C� C_ ; i � Apt. Floor City C'\C`.._A� C� Suburb <br /> Occu pant Owner <br /> Heat Loss Date Htg. Inst. Gas Co. Meter Badge <br /> S o I d By i�l ��� L���� � Installed By i c1✓1 � <br /> � <br /> Electrical Work By Gas Line By J� �}1 � <br /> Type of Heat GA FA v HW Space Htr. Unit Htr. Other���=� '� �'���� <br /> Gas Design Conversion ��c�i�0 � � �� <br /> 'I � Make of Burner Model <br /> Make L�r� ��r �` Model Ti 1�� �C � l�C'` ( <br /> c� / c Max BTUh rating <br /> Serial �� l C_ S ��.�C>� Input ��C 1��� ��' � <br /> Make of Furnace Model <br /> Controls � <br /> ���= < < ����;.�+Y�� �c''ry`'� -� , � Vent Size Kind of Liner <br /> Thermostat "��l?C? Heat Plug <br /> t Size None <br /> Valve � .'� � 1��> 1hc�T�.imit 1�► , XG 6'� 2 � <br /> Draft Hood V�C?h � Regulator 7 � � <br /> Limit Setting f�� ` Fan Setting �S � I ZS (.L?F� 11G�� (�.J�1 ��� <br /> Filters Size x x TVumber <br /> Pilot Type rZ c-� c i � Pilot Make t= �� nc.� �C <br /> . Chimney Location Inside �-.-- Outside <br /> Pilot Model Ni7 l � Pilot Timing " _ � �;��t(���'�=' k��1 y ,(� <br /> �{tic�� ��.c, '�`�` Chimney Construction ��� '�` ��J- <br /> L.W.Cut off <br /> � Smoke Bomb Wring C� <br /> Pressure C�`- � Percent CO2 J. � °� Input CFH�°'�0�6 <br /> Draft `� u� � Test Tag Door Pressure <br /> Percent O�°� Stack Temp '� Percent CO�_°,6 <br /> Date Tested L , - Z� %� Company J`�r `' � ' �j� <br /> Name of Tester <br /> White=Office Canary=InspectorlCity Pink=Jobsite OC.� 3 0 1g95 <br />