Installation Certificate From Specialised Company - GOK LWG 2000 Notice De Montage Et De Service

INSTALLATION CERTIFICATE FROM SPECIALISED COMPANY

I hereby confirm that the
following safety device was
installed correctly:
in accordance with the applicable assembly and operation manual. After INSTALLATION,
the safety device was started up and subjected to a FUNCTION TEST. Upon start-up, the
safety device operated properly. The operator was informed about the operation, care and
maintenance of the leak alarm in accordance with the assembly and operating manual.
The assembly and operating manual along with a copy of the general building-authority
approval was handed to the operator and is in the possession of the operator.
Specialised company is
Operating medium or stored material ►
1)
More detailed description of the
operating medium
2)
Proof of function from the manufacturer's tests: Immerse the probe in the operating medium to be
tested. Leave in a heating cabinet at + 60 °C for 48 hours. Then carry out the specified FUNCTION
TESTS at ambient temperature. A certificate of the test and the result must be issued.
Address of operator
Place, date
The safety device(s) was (were) subjected to a recurring FUNCTION TEST and worked
correctly at that time.
Place, date
16 / 16
• To be kept by system operator.
• Important for any warranty claims.
 Leak alarm, Type LWG 2000
 Leak alarm, Type LWG 2005
►  Specialised company according to water law
 (Electrical installation) company
 Waste oil
 FAME
 Fuel oil
 Heavy fuel oil
 Water or oil-water mixtures
 Other water-hazardous, non-flammable
►
Recurring FUNCTION TEST
Regler- und Armaturen-Gesellschaft mbH & Co. KG
Obernbreiter Straße 2-18 • 97340 Marktbreit / Germany
Tel.: +49 9332 404-0 • Fax: +49 9332 404-43
E-Mail: info@gok-online.de • www.gok-online.de • www.gok-blog.de
Leak alarm type LWG 2000
 Diesel fuel
 Aqueous urea solution
 Bio fuel oil
 Industrial oil
1) + 2)
liquids
Address of specialised company
Specialised company(stamp, signature)
Specialised company(stamp, signature)
part no. 15 073 57 c