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PW1C Schedule C Heating Combustion Equipment Orient and affix BIS job number label here Application Must be Typewritten. 1 Filing Status Required for all applications. Tanks Tank 1 Tank 2 Tank 3 Tank 4 Oil Grade Grade 1 Kerosene Grade 4 Capacity gal. Grade 2 Diesel/Bio Diesel PW1C 01/11 PW1C PAGE 2 8 Chimney Information Walls made of Lining made of Full Name Statement Regarding Construction of Existing Chimney I attest that have inspected the chi.

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