Installation and Service Certificate
Boiler Data
Boiler Model / Series
Evergreen
®
__________ / Series _____
Date installed _____________________
CP Number ________________
FUEL: Natural ______ LP ______
Btu Input ___________________
CERTIFIED THAT
:
❏
Installation instructions have been followed.
❏
Check-out sequence has been performed.
❏
Information on next two pages is certified to be correct.
❏
Information received and left with owner/maintenance person.
Installer
(Company) (Address) (Phone) (Installer’s Signature)
Part number 550-100-131/0120
– 131 –
®
gas
-
fired
water
boiler
— 220/299/300/399
Boiler Manual