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This performance check report should be filled out by installer and retained with unit.
DATE:
1. UNIT:
Mfgr
THERMOSTAT:
Mfgr
2. Person Reporting
3. Company Reporting
4. Installed By
5. User's (Owner's) Name
Address
6. Unit Location
WATER SYSTEM INFORMATION
7. Open Loop System (Water Well)
A. If Open Loop where is water discharged?
8. The following questions are for Closed Loop systems only
A. Closed loop system designed by
B. Type of antifreeze used:
C. System type:
D. Pipe Material
E. Pipe Installed:
1.
Horizontal
No. pipes in trench
2.
Vertical
GROUND SOURCE HEAT PUMP
PERFORMANCE REPORT
Model #
Model #
Series
TAKEN BY:
Date Installed
Closed Loop System
% Solution
Parallel
Nominal Size
Total length of pipe
Depth bottom pipe
Total length of bore hole
S/N
P/N
Manual 2100-419E
Page
47 of 48
ft
ft
ft
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