INTERRUPTION OF SERVICE
PERFORMED SNIFF TEST Y N
REGULATOR(S)
INSTALLED
Manufacturer Model # Date Code Condition Vent Position How Protected COMMENTS:
System Type
Initial/Start Pressure End Pressure Start Time End Time Start Time End Time Flow Pressure Test Lock-Up Pressure Test WC
PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
Start Pressure End Pressure
PSI PSI
PSI PSI
PSI PSI
__ Stage
__ Stage
__ Stage
__ Stage
__ Stage
__ Stage
__ Stage
__ Stage
PSI PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
WC
PSI
Pressure Test System Operation Tests
© Boston Environmental, LLC
Account # Name Address City State Zip Phone Date of Inspection Branch/Location Work Order # Manufacturer
Year Manufactured
Model #
Serial #
Fuel
BTUs (Maximum Input)
Manual Shutoff Valve
Sediment Trap
Burner(s) Condition
Combustion Chamber Condition
Control/Pilot Safety System
Venting System
Combustion Air
Taken Out of Svc or Operation (Tag #)
Equipment Type
Service Technician Name - Print Customer Name - Print Service Technician Signature Date Customer Signature Date V2
System Leak Check Entire System
Leak and System Check Out of Gas Gas Leak/Odor Complaint Install New Gas Piping Put System/Appliance Back in Service Container Swap Container Drop-O /Pick-Up Regulator Replacement Other: REASON
8
10
n
8
n
12:48 12:53
Equipment: serial# Dk9771694; serial# Nv; serial# Nv; Regulators: model# Nv;
04/24/2025
n
TJ Kennedy MARY LAUREL YOUNG
04/24/2025
2025
399448 MARY LAUREL YOUNG [1] THOMAS L YOUNG 5440 TRUMAN MTN. RD.
[AG]
GAINESVILLE
GA 30506 470-***-**** 4/24/2025
Water Heater Furnace Cooktop
Ruud
2006
Bradford White JennAir
Mi5036fcx Nv Nv
Dk9771694 Nv Nv
Propane Propane Propane
36,000 75,000 75,000
OK OK OK
OK OK N/A
Service Not Provided OK OK
Service Not Provided Service Not Provided Service Not Provided OK Pilot Service Not Provided OK Electronic
Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided Service Not Provided No No No
Inte
gral
Int
egr
al
Fisher Nv 2015 OK OK OK
n