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Gas Integrity Test & Gas Turn on Affidavit Form 2009
Equipment (specify):
___________________________________________
___________________________________________
Contractor to Check Appropriate Corrective Condition:
I have repaired and tested,
_____ Leak at gas equipment (specify unit or equipment) ________________________
_____ Control Valve
_____ Pilot Valve
_____ Hood Draft
_____ Appliance Regulator _____ Flue Connection
_____
Appliance Valve
_____ Other (Specify) and or Provide Details For Above Items Checked...
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