Appendix 4 Form For Final Delivery Of Store H 2 O - Dik Geurts STORE H2O Mode D'emploi

Appendix 4 Form for fi nal delivery of Store H2O
Dik Geurts
The Netherlands
Form for fi nal delivery of Store H2O
Build-in date:
Client:
Street:
Postal code:
Chimney height:
Material:
Height above ridge?
Cleaning possibilities:
Ø CH connection:
Ø water connection:
Declaration of delivery:
The user hereby declares that the appliance
has been delivered in working order and that
he/she was explained how to use and
maintain the appliance:
Date and signature user:
.........................................
......................................... House number:
......................................... City:
................................m
..................................
.................................m
...................................
..............................mm
..............................mm
Cross-section:
Hood?, if so, which type:
Valve?:
Air supply:
Pump unit (obligatory)
Control temperature pump unit
Firm stamp:
Date and signature installer:
19
...................................
...................................
..............................m
................................
................................
....................................
......................................
..................................°C
Dik Geurts