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�3�3 ✓ <br /> HOUSE HEATING TEST RECORD �� ' <br /> ADDRESS ��� ����� "�""`- ��" APT. F OR CITY �" 'aSUBURB <br /> OCCUPANT t� OWNER ���.�—��i � � <br /> HEAT LOSS DATE HTG. INST. b `L <br /> SOLD BY �S� =S INSTALLED BY <br /> Electrical Work By %���/ LEC�/7�'LL'� Gas Line By <br /> TYPE OF HEAT GA FA '�1 ._HW STEAM SPACE HTR. UNIT HTR. OTHER <br /> GAS DESIGN CONVER51 N <br /> MAKE ��7�-UL —MAKE OF BURNER AY ���? <br /> Mod�l .���1�0 — � Model E EIVED <br /> Serial ��� �2 �'y7o Max. BTU Ratiny p v Q n <br /> INPUT ��`���� MAKE OF FURNACE E�i�.i � ,7 �J�2 <br /> Model <br /> _��� ,s�NTROLS ;, Q �1I0lJN� PtAN1�1NG Sc INSP. <br /> THERMOSTAT Heat Pluy V�nt Size � r ' J �� <br /> Valve f KIND QF LINER $IZE NONE <br /> Limit � � �,.��J Draft Hood RegulaTor <br /> Limit S�Niny G � �� f� Filt�rs $ize Number <br /> Fan Setting `C ` �� Chimney Location I�side Outside <br /> Pilot Typs Chimney Construction <br /> Pilot Make <br /> Pilot Model $moks Bomb Wiring <br /> Pilot Timing Draft Test Tay <br /> L.W. Cut Off Door Pressure Lightiny Inst. <br /> Pressure P�rcent CO� � � Date Tested � � �� <br /> Input CFH Perc�nt 0 - � Company Testing ON' / . /N�- <br /> 2 <br /> Stack Temp. � 2� Perc�nt CO � Name oi Tester <br /> Form 235 <br />