Dunkirk XEB-3 Installation, Operation & Maintenance Manual page 31

Boiler Manufacturer:
Dunkirk Boilers
85 Middle Road
Dunkirk, NY 14048
Boiler Identification:
Model #:
Serial #:
Measured BTUH input:
Operational Test Date:
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Installation Instructions in the XEBInstallation,Operation and MaintenanceManual have been followed.
Initial Operational BoilerTestCheck-Out Procedure has been performed.
Information on this form is certifiedto be correct.
Allboiler instructions, wiring diagrams, piping diagrams, and supporting information shipped with this boiler
forwarded to owner/maintenance personnel.
Installation Location:
Customer Name:
Address:
City: State:
Installer Information
Company/Contractor:
Address:
City: State:
Telephone #:
Installer's Signature Date:
Installer's Printed Name:
Zip:
Zip: