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BoilerData
Boiler Model / Series Evergreen
®
__________ / Series _____
Date installed _____________________
CP Number ________________ FUEL: Natural ______ LP ______ Btu Input ___________________
CERTIFIEDTHAT:
Installation instructions have been followed.
Check-out sequence has been performed.
Information on next two pages is certied to be correct.
Information received and le with owner/maintenance person.
Installer
(Company) (Address) (Phone) (Installer’s Signature)
Part number 550-100-211/0122
– 131 –
220 /29 9/3 00 /39 9
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