Membrane controlled anti-siphon device
Regler- und Armaturen Gesellschaft mbH & Co. KG
Obernbreiter Str. 2-16 • D-97340 Marktbreit
Tel.: +49 9332 404-0 • Fax: +49 9332 404-43
E-mail: [email protected] • Web: www.gok-online.de
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Important for any warranty claims
To be kept by system operator
Installation certification from specialised company
Membrane-controlled anti-siphon device type HS-V.2
I hereby confirm that the anti-siphon device type HS-V.2 was installed in accordance with the
valid installation and operation instructions. After INSTALLATION, the device was started up
and CHECKED.
The anti-siphon device type HS-V.2 functioned correctly on the start-up date.
Year of
manufacture
Type HS-
V.2
with adjustable safety level between
HA = 0
4 m
Set HA
= m
Height
H
Height difference between the maximum
filling height of the tank and the lowest point
of the suction line
= m
Height
X
Height difference between the installation
position of the HS-V.2 membrane-controlled
anti-siphon device and the lowest point of
the suction line
= m
Operating
medium
Fuel oil EL
Address of the operator
Address of the specialised company
Place, date
Specialised company (stamp, signature)
Recurring FUNCTION CHECK
The anti-siphon device type HS-V.2 was subject to a recurring FUNCTION CHECK and
functioned correctly at this time
Place, date
Specialised company(stamp, signature)
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