Warranty

First Name

Last Name

Company Name

Telephone

Email

Address

City

State

Zip Code

Job and/or Serial Number

Located on the vessel name plate on your boiler.

Installed By

Installation Location

Delivery Date

Installation Date

To activate your manufactures warranty this card must be filled out and returned with a copy of the HBC startup report located in the operators manual. Startup report must be completed by the authorized boiler / burner technician.

Date of Startup

Job#

Project Name

Location

Boiler Serial

Burner Mfg

Boiler Model

Burner Model

Boiler Rating (MAWP)

Burner Input (MBH/GPH)

Burner Serial

Boiler Heating Surface (SQ/FT)

Type of Fuel

Was the Boil Out and Rinse Completed?

Yes

No

ALL SAFETY CONTROLS MUST BE TESTED

General Control Settings

Operating Press. Control Cut-off Setting (psi)

Operating Press. Control Cut-on Setting (psi)

Operating Temp. Control Cut-off Setting (°F)

Operating Temp. Control Cut-on Setting (°F)

High Steam Press. Limit Control Cut-off Setting (psi)

High Temp. Limit Control Cut-off Setting (°F)

Flame Safegard Control Mfg

Flame Safegard Control Model

Does Owner Have O&M Manuals?

Yes

No

Gas Control Settings

Low Gas Press. Switch (I.W.C/psi)

High Gas Press. Switch (I.W.C/psi)

Gas Pressure at Train Inlet

Burner in OFF Position (I.W.C/psi)

Pressure at Gas Train Inlet

Low Fire

High Fire

Gas Pressure at Firing Head

Oil Control Settings

Low Oil Pressure Switch (psi)

High Oil Pressure Switch (psi)

Operations Checklist Checked for Proper Operation of

Low Water Cut-off

Yes

No

High Water Cut-off

Yes

No

Flame safeguard control ignition failure

Yes

No

Flame safeguard control main flame failure

Yes

No

Burner air flow switch

Yes

No

Fresh air damper and switch

Yes

No

Barometric damper

Yes

No

Boiler room combustion air and ventilation provisions correct

Yes

No

Oil tank vent system checked

Yes

No

OC All oil lines checked for leaks

Yes

No

All gas lines checked for leaks

Yes

No

Gas lines and controls properly vented

Yes

No

Exhaust Height (ft)

Exhaust Size/Diameter (in)

Exhaust Breeching Size

Exhaust Breeching Length

Unit Outlet Damper (% Open)

Sequence Damper Control Model

Sequence Damper Control Mfg

Oil Tank is

Above Burner

Below Burner

Distance From Tank (ft)

Vertical Lift (ft)

Pressure at Suction Side of Pump (psi)

Suction Line Size

Pipe

Tubing

Field Combustion Settings

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Low

Medium

High

A) Firing Rate %

B) CO2 %

C) O2 %

D) Smoke or CO (ppm)

E) NOx (ppm)

F) Stack Temp. Net, (F)

Having read the Manufacturers’ Service Manual as to the proper installation, start-up and service of the above unit, I verify that the burner has been put into operation as specified, and that the above information and checks are complete and correct.

Verify