MINI-SPLIT FORM

ADDRESS

MINI-SPLIT DATA
TIME/DATE OF VERIFICATION

Month Day Year
at
Hour Minutes AM/PM Option Date Picker Icon
OUTSIDE TEMPERATURE
MINIMUM REQUIRED SYSTEM AIRFLOW RATE (CFM)
INITIAL VACUUM LEVEL AND TIME
FINAL VACUUM LEVEL AND TIME
CONDENSER MODEL NUMBER
STANDARD CHARGE (LBS., OZS.)
STANDARD LIQUID LINE LENGTH AND DIAMETER
STANDARD EVAPORATOR COIL SIZE (TONS)
CHARGE ADJUSTMENT FACTOR (OUNCES/FOOT)
INSTALLED LIQUID LINE LENGTH (FEET)
INSTALLED LIQUID LINE DIAMETERS (TYP. 3/8”)
INSTALLED EVAPORATOR COIL SIZE (TONS)
CHARGE CORRECTION CALCULATION (LBS., OZS.)
INITIAL REFRIGERANT CYLINDER WEIGHT
FINAL REFRIGERANT CYLINDER WEIGHT
INSTALLED REFRIGERANT WEIGHT