PL-03-21-550 DROP TESTqFopeve rrGas
18111 NW 68 AVE UNIT I-105
Hialeah FI, 33015
305- 298 -0193 Cell
305- 331- 2572 Office
Forevergas@live.com
NAME:
ADDRESS
DROP TEST CERTIFICATION
PERMIT NUMBER:
�1L� k,) N DATE: C' �Z-%
CITYh 1 e4 e) s- r zIP,
THIS LETTER IS TO CERTIFY THAT DROP TESTOREVER GAS
HAS A THIRTY DAY V� �RQNTY FROM HE TESTED
FORM A DROP TEST TO
CHECK THE WHOLE GAS LINE.TH
DATE
TYPE OF INSTALLATION:
THIS IS FOR A:
NEW
❑ WATER HEATER
❑ STOVE/RANGE
❑ BARBECUE
EXISTING
,GAS GENERATOR.
❑ OVEN
❑ POOL HEATER
❑ OTHER
NATURAL CAS: ❑ PROPANE GAS:
SYSTEM PRESSURE FROM METER: r,�'— SYSTEM PRESSURE FROM TANK
WATER COLUMN:
TEST DURATION:
DATE OF TEST: .? ; ' "� �16
WATER COLUMN
FLOW
PSI
TEST ()uRATION
Z11.V;4AYRTHER GIUESTIONS, PLEASE CALL 30&298-0193
DATE: 3I 7O EZ
CONTRACTOR (QUALIFIER)
�DATE: -
114AT E OF NOTARY IC
LOCKUP
STATE #:'28319
C6'0 LPG 26379
` Ay * Femand0z
NOTARY PUBLIC
1?m STATE OF FLORIDA
Commit GG340031
r1* �� Expires 5l3012023