Unit Installed By ________________________________  Date  ______/ _______/ _____

            For Service  call     ______________________________________

Heat Loss requirement             _______________________________________  BTU/h

Outdoor Design Temperature   ___________________________________

Boiler Manufacturer                _______________________________________

Model #                                 _______________________________________

Serial #                                   _______________________________________

Actual Heat Loss                        ________________________________________ BTU'h

                                      The following should be adjusted to manufacturers Spec's
                                                            See Installation Manual

  Combustion Efficiency                             _____________________%

Smoke Reading                                        _____________________

Co2 (%) or O2 Reading                          _____________________

Gross Stack Temperature            (F)       _____________________

Boiler Room Temperature                  _____________________

Net Stack Temperature                         _____________________

Draft OF or Breech                                _____________________" W.C.

Nozzle Size                                            _______/ _________ / ________

Pump Pressure                                       ____________________  PSI

Aquastat Settings                                   ____________________  Low (If applicable)

                                                             ____________________  High

                                                             ____________________  Differential (If triple action aquastat should be 20-25 Degrees)

Circulator pump away from tank connection?       Yes / No

If cast iron boiler, boiler Protection?                     Yes / No

Good quality 10 Micron oil filter?                         Yes / No     (usually a spin on)

Technician _________________________________________________________________________________________        Keep for your records of installation date and original set-up information

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