State Water Heaters PRV 30 NORS G Installation And User Instructions Manual page 27

Important
This form should be filled in completely
within two weeks of installation.
MODEL: .........................................................................................................................
SERIAL NUMBER: .........................................................................................................
ORIGINAL DATE OF INSTALLATION: ............................................................................
NAME OWNER: .............................................................................................................
ADDRESS: ....................................................................................................................
TOWN: ..........................................................................................................................
(STAMP) INSTALLER: ...................................................................................................
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