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XVII. INSTALLATION & CHECKOUT CERTIFICATE
Boiler Model___________________Serial #___________________Date Installed_____________
Measured BTU/HR Input___________________
o Installation instructions have been followed
o Checkout procedure and adjustments performed
o Maintenance and Service issues reviewed with owner/ maintenance person
o Installation booklet affixed on or adjacent to boiler
Installer (Company) __________________________________________________________
Address ___________________________________________________________________
Phone _____________________________________________________________________
Installer’s Name _____________________________________________________________
Signature __________________________________________________________________