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GOK LAG 2000 A - Installation Certificate from Specialised Company

GOK LAG 2000 A
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Leak detector type LAG 2000 A
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.de • www.gok-blog.de
28 / 28 part no. 15 071 53 e
INSTALLATION CERTIFICATE FROM SPECIALISED COMPANY
To be kept by system operator.
Important for any warranty claims.
I hereby confirm that the following
safety device(s) was/were installed
correctly:
Leak detectorTyp LAG 2000 A
Leak detector for systems containing
acc. to EN 13160-1/EN 13160-3 (TRbF 501 F)
We hereby certify that the LAG 2000 A leak detector was installed in accordance with the applicable
assembly and operating manual. After it was installed and before start-up, the device was subjected to a
function test. On start-up the leak detector functioned properly and as intended. The operator was
informed about the operation, maintenance and repair of the LAG 2000 A in accordance with the
assembly and operating manual.
Specialised company is
Specialised company according to water law
(Electrical installations-) company
Device no. LAG 2000 A
Year of manufacture, LAG 2000 A
External alarm
Tank manfacturer
Year of manufacture/Factory no. of the tank
Tank storage
above ground
Norm:
underground
Storage volume
litres
Volume of the monitoring space
litres
Storage operating medium
Leak detector liquid
Number of leak detector liquid tanks
units
The leak detector was installed as a replacement on an existing underground tank within the scope
of TRbF 501.
Type (old)
Device no. (old)
Address of operator
Address of specialised company
Place, date
Specialised company (stamp, signature)

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