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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 __________________________________________________