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Artikel-Nr. 15 513 50 c
INSTALLATION CERTIFICATION FROM SPECIALISED COMPANY
Membrane-controlled anti-siphon device type HS-V.2
Important for any warranty claims
To be kept by system operator
I hereby confirm that the anti-siphon device type HS-V.2 was installed in accordance with the
valid installation and operation instructions. After ASSEMBLY, the device was started up and
FUNCTION CHECKED.
The anti-siphon device type HS-V.2 functioned correctly on the start-up date.
Year of manufacture
Batch number
Type HS-V.2
with adjustable safety height
between HA = 0
÷
4m
Set adjustable safety height 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 L
……………….
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)
