Title Page
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Client / Site
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Contact
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Conducted on
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Technician
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Unit Name
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Unit Type
- Split System
- Heat Pump
- Air Handler
- Condenser
- Heater
- Fan
- Chiller
- Boiler
- WSHP
- Pump/Type
Unit Information
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Unit Name
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Unit Type
- Split System
- Heat Pump
- Air Handler
- Condenser
- Heater
- Fan
- Chiller
- Boiler
- WSHP
- Pump/Type
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Suct. & Disc. Pipe Size?
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Picture Of Unit and Tag
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Model #
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Serial #
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Replacing Entire Unit?
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Equipment Location?
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Repair Description
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Pictures of Repair to be Made
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Part(s) # (If Available)
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Does the Repair require a Crane?
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Roof Height, Dist. From Edge & the Building
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Any Special Circumstances?
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What Circumstances?
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Unit Location?
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Voltage Requirements (110,208/230,480)
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Amp Rating (20,30,40, Etc)
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Phase
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Capacity Of Unit (Tons, H.P., CFM's)
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Need a New Disconnect?
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Line/Load side Wire Size?
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Dimensions of the unit
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Is a Economizer Package Existing?
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Is Low Ambient Operation Required?
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Is a Smoke Detector Required?
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Is Control Work Required?
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What Type Of Controls?
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What Type?
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Time Needed For the Job?
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Technician Signature
