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ADDRESS <br />OCCUPANT. <br />/.oBS' <br />HOUSE HEATING TEST RECORD <br />0/h/L B /U- <br />-APT...FLOOR CITY .SUBURB. <br />HEAT LOSS_____________DATE HTG. \US7. 1__________ <br />SOLD BY ^tUJ •////g» iMi^TAi I pn bY rt-*/ «S* <br />___________________Gas Lino By _____________________________________________ <br />OWNER C?- >ltf, ^Jt? c, \ <br />Eloctricai Work By ____ <br />TYPE OF HEAT GA FA ^JL,HW STEAM .SPACE HTR..UNIT HTR..OTHER <br />GAS DESIGN <br />MAKE _ _ _ _ _ _ <br />Modol ^ O S //C -d <br />Serial 9 Ci :T J^'^9 ^ <br />— (c^ <br />INPUT____/^1.. <br />CONTROLS <br />THERMOSTAT T?.k.^------ Hoot Plug <br />Valve ''lT'io/i A/ S ___________ <br />Limit . ^ <br />Limit Setting <br />Fan Setting _ <br />Pilot Type __ <br />Pilot Make __ <br />Pilot Model ... <br />Pilot Timing. <br />L.W. Cut Off <br />Q <br />•i-tA/(E.L-^ <br />// o ^ Q <br />ps: Jiz <br />/ ^ S A-/A <br />Pressure.3,^ <br />Input CFH II ^ ^ <br />Stock Temp. <br />Form 235 <br />4*0 o <br />-Percent CO^ <br />. Percent 0^ <br />.Percent CO <br />CONVERSION <br />MAKE OF BURNER <br />Model <br />Max. BTU Rating <br />MAKE OF FURNACE <br />Model _______________ <br />Vent Size______: <br />KIND OF LINER <br />Draft Hood------------------ <br />Filters Size <br />Chimney Location <br />Chimney Construction <br />SIZE.6 NONE. <br />. ReguloTor <br />___Number. <br />Inside.. Outside <br />Smoke Bomb <br />Droft — __ <br />Door Pressure. <br />Dote Tested_ <br />.Wiring------------- <br />^Test Tag-------- <br />. Lighting Inst. <br />Company Testing <br />Nome of Tester _