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INSTALLATION AND CHECK-OUT CERTIFICATE
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 affixed on or adjacent to boiler
Installer (Company)
Address
Phone
Installer's Name
Signature
PN 240013415 REV A [08/15/2021]
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