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ADDRESS 4. <br />G TEST RECORD <br />■‘^SSess^'■V •-. <br />APT. <br />OCCUPANT <br />HEAT LOSS <br />SOLD BY <br />OWNER <br />SUBURB <br />EUctricpI Work By____ <br />TYPE OF HEAT CA <br />INSTALLED BY <br />Gas Lina By_________________ <br />STEAM SPACE HTR.UNIT HTR.OTHER <br />GAS DESIGN <br />CONTROLS <br />Heat Plug <br />Limit Setting — <br />Fon Setting—C <br />Pilot Typ«_v^ <br />Pilot Moko <br />Pilot Modol <br />Pilot Timing <br />L.W. Cut Off <br />^XMC: <br />Protsufo —Z <br />Input CFH <br />Porcont C0< <br />Porcont 0. <br />Stock Tomp, —T ■■ Pofcont <br />Form 235 <br />CL <br />CONVERSION <br />MAKE OF BURNER <br />Model____________ <br />Max. BTU Roting <br />MAKE OF FURNACE <br />Model_____________ <br />Vent Size <br />KIND OF LINER__ <br />Draft Hood______ <br />Filters Size <br />SIZE NONE. <br />Ro^ulofor <br />—Numbor <br />Chimnoy Location <br />Chimnoy Construction <br />Insido Outsido <br />Smoko B <br />Draft <br />Wiring <br />Door Prossuro <br />Doto Tostod__ <br />T... To, <br />Lighting Inst. \J------ <br />^------------------------ <br />Company Testing <br />Name of Tostor <br />'A <br />r. <br />i <br />stieiaiU . • > ...^xaMsisai mg