HomeMy WebLinkAbout636 FOXTAIL ST - SPECIAL INSPECTIONS - 1/29/2016214-5134
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combustaw Safes Teg
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I hereby attestthatI have pe Inned %e b$owing
Fort Ca lies Combustion Safety Test 43
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Appliance Tested: J
Appuance Replaced:
COMM RNYIDavetapumerrs
281 N. CollageAve.
F9 sor680
Fort CcUIM CO 80-a22
. 97Q,496.2740
870.E24.6934(fax)
_ fcgovsorrldaystopment
hmesrOTIM
in Faint g Houses
Safety Testis accordaa=wft
sS,Febmary2012.
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' e Duration (m seconds): CaEbon liaono d a peeME*: j
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Pass ail Daft Tested- t' a Z r; � � I
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spivage Duration ck seconds): CarbonMonoxi a (pasts perm?llson):
?ass Fail Date Test;
(FQalerl MOWS sor, C dmrzs M99 MtRawes 8 ai6Ifa8ravd C®nmens)
Techaiciea s recommendation to corre.ttested appliance failure:
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I
r`a ed1 Went twat; CL4'aMMOMI..
I Bert* that Y ant the legal owner ofthe above listed property and teraby soimowledge that nor appliance
has MQed a Combustion Safety Test underwaW-ease coadMom I aolmowledge that I have lee'v ct a
combustion appliemce safety inhMaiion sheet. j
Owner's Name (print)
owner's 5ionaime_
C5 ``.[eplacemenVaaeual-dMw42&12
Date I
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