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Boiler Model ___________ Serial # _____________ Date Installed___________
Measured BTU/HR input ____________
Installation instructions have been followed
Checkout procedure and adjustments performed
Maintenance and Service issues reviewed with owner/ maintenance person
Installation booklet affi xed on or adjacent to boiler
Installer (Company) __________________________________________
Address ___________________________________________________
Phone _____________________________________________________
Installer's Name _____________________________________________
Signature __________________________________________________
INSTALLATION AND CHECK-OUT CERTIFICATE
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