| __________________________________________________________________________________ |
| Job name: |
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| __________________________________________________________________________________ |
| Job address: |
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| __________________________________________________________________________________ |
| Unit ordered: Model: |
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| Voltage: |
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| Min. turn-on flow: |
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| Temp. setting: |
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| __________________________________________________________________________________ |
| Brief description of application: |
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| __________________________________________________________________________________ |
| Flow range desired: |
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| __________________________________________________________________________________ |
| Print name: |
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| __________________________________________________________________________________ |
| Signature: |
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| __________________________________________________________________________________ |
| Title: |
Date: |
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| __________________________________________________________________________________ |
| Eemax use only |
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| Serial Number: |
Manufactured date: |
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| __________________________________________________________________________________ |
