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HEATING <br /> AIR CONDITIONING HOUSE HEATING TEST RECORD <br /> AND ELECTRIC, INC. <br /> ADDRESS ` l APT. FLOOR CITI'�" "O�� SUBURB <br /> OCCUPANT 1�e' �.' OWNER �'� <br /> HEAT LOSS G`� DATE HTG.INST. ��/�I D'Z ,� <br /> SOLD BY � , INSTALLED BY l?��� �a���"�� <br /> Electrical Work By "� Gas Line By <br /> TYPE OF HEAT GA FA�_ HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> GAS DESIGN CONVERSIUN <br /> , <br /> MAKE <br /> Model �d — �— �Z. Vent Size ��� 2 <br /> Serial r KIND OF LWER C��5 i !�_ SIZE�� NONE <br /> INPUT l �� �� Draft Hood �k�k���� Regulator �e.� <br /> Filters Size ��a X Z 3 X Number / <br /> CONTROLS Chimney Location Inside �C Outside <br /> THERMOSTAT Heat Plug Chimney Construction e- ��� �i <br /> Value � <br /> Limi Smoke Bomb Wiring , <br /> Limit Setting � Draft Test Tag � � <br /> Fan Setting T� Door Pressure Lighting Inst. �l�� <br /> Pilot Type f � �� C. � Date Tested — — Z —�— <br /> Pilo[Make C..O�Y✓���— Company Testing � � - <br /> Pilot Model �� � Name of Tester_� i <br /> Pilot Timing_ _ �0 �-. <br /> L.W.Cut Otf <br /> � <br /> Pressure ��c�,� �- �� Percent COZ Pressure _ Percent COZ <br /> Input CFH �'Cr Percent OZ � O Input CFH Percent OZ <br /> Stack Temp. „3�d d Percent CO /��/1�d1 Stack Temp. Percent CO <br />