HomeMy WebLinkAbout7245 Fort Morgan Dr - Special Inspections/Combustion Safety - 03/31/2016Mar 31 1611:39a Swan Heating and Air
r-t Collins
Combustion Sal
Replacement of Natural
Address: '39
970-613-0826 p.1
r?Y ing, Dove lop rnert <? T ranspo'-atiffon Services
Community Development & Neighborhood Services
281 North College Avenue
P.O. Box 580
Fort Collins. CO 80522.0580
970.416.2740
970.224.6134- fax
rcgovxom
est Compliance Form
Appliances in Existing Houses
Permit Number: fj (-e0 I � � 5
Approved Agency: "
I hereby attest that I have been trained as an proved Agency and have performed the following
Combustion Safety Test in accordance Fort Collins Combustion Safety Test Guide
Version 5 February 2012.
Technician Name (print):
Technician Signature:
Appliance Tested: V
Appliance Replaced:
Worst Case Conditions:
Spillage Duration (in seconds): �.
Pass Fail l
Natural Conditions:
Spillage Duration (in seconds):,'
Pass Fail l
I
(Failed test requires corrections ui`
Technician's recommendations to correct tesl
i
Failed Worst Case Conditions:
1 certify that I am the legal owner of the above
has failed a Combustion Safety Test under wor
combustion appliance safety information sheet.
Owner's Name (print)
Owner's Signature
CST:replacement/natural-dmtV4.25.12
Company S\Oj o
Date
on Monoxide (parts per million):
Tested: 31'?LNa
Monoxide (parts per million):
Tested:
test passes under Natural Conditions)
appliance failure:
property and hereby acknowledge that;my appliance
le conditions. I acknowledge that I have received a
Date