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240012994 Rev. B [08/31/2020]
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 axed on or adjacent to boiler
Installer (Company)
Address
Phone
Installer’s Name
Signature
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