Conducted By:

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type 1
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Spine pipe size:

Boiler Type:

No. of boilers:

No. of radiator zones:

Location of isolators:

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No. of radiators - zone 1

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No of radiators zone 3

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No of radiators zone 5

Date isolation last used / checked:

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Condition of isolators:

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Approx water volume

General system condition

Last flush date (approx)

Last dose date (approx)

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Flow rate

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Header exchanger locations (please add descriptions to images)

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Dirt & air seperation type

Dirt & air seperater condition

Dissolved oxygen reading

Balance equipment in situ?

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