Boiler Model
Measured BTU/HR input____________
Installation instructions have been followed
Checkout procedure and adjustment s performed
Maintenance and Service issues reviewed with owner/ maintenance person
Installation booklet affixed on or adjacent to boiler
Inst aller (Company)
Installer's í Name
Signature
Copyright 2006 CAC / BDP S 7310 W. Morris St. S Indianapolis, IN 46231
Manufacturer reserves the right to change, at any time, specifications and designs without notice and without obligations.
INSTALLATION AND CHECK-OUT CERTIFICATE
Serial #
Address
Phone
Date Installed___________
Printed in U.S.A.
Edition Date: 3/06
44
A04082
Catalog No:IM- - BW9A- - 05
Replaces:IM- -BW9A- -04