64659-001 REV. A 07/06/18
2
INSTALLATION LOG
BURNER MODEL:
SPECIFICATION NUMBER:
FUEL (NATURAL OR
PROPANE):
GAS ORIFICE DRILLED
SIZE:
INLET GAS PRESSURE
(in. w.c.):
CO
2
(%):
O
2
(%):
CO (PPM):
INSTALLER’S NAME:
CONTRACTOR NAME:
CONTRACTOR ADDRESS:
CONTRACTOR PHONE
NUMBER:
CONTRACTOR LICENSE #:
DATE OF INSTALLATION:
COMMENTS ABOUT INSTALLATION/START UP:
THESE INSTRUCTIONS SHOULD BE AFFIXED TO THE BURNER OR ADJACENT TO THE APPLIANCE.
BURNER/APPLIANCE SERVICE LOG
SERVICE
DATE
TECHNICIAN
COMPANY
/ ADDRESS
CONTRACTOR
LICENSE #
WORK PERFORMED
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
