Unit Installed By ________________________________  Date  ______/ _______/ _____  

            For Service  call     ______________________________________

Actual Heat Loss                     _______________________________________  BTU/h

Boiler DOE Output                  _______________________________________ BTU/h

Outdoor Design Temperature   ___________________________________

Boiler Manufacturer                _______________________________________

Model #                                   _______________________________________

Serial #                                    _______________________________________

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

Combustion Efficiency                                 _____________________%

Smoke Reading                                      _____________________

Co2 (%) or O2 Reading                          _____________________

Gross Stack Temperature            (F)       _____________________

Net Stack Temperature                           _____________________

Draft OF or Breech (Pressure fired boilers) _____________________" W.C.

Nozzle Size                                            _______/ _________ / ________

Pump Pressure                                       ____________________  PSI

Aquastat Settings                                   ____________________  Low (If applicable)

                                                             ____________________  High

                                                             ____________________  Differential (If applicable) 

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