Performance Certication
kENDALL
tyco/ Healthcare
182531
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ª5:$0)&"-5)$"3&(3061-1t"--3*()543&4&37&%tt*/64tXXXUZDPIFBMUIDBSFDPN
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Serial Number
Date of Re-Certication
The undersigned hereby certies that the above referenced pump has been tested per the pump’s
internal re-certication protocol with the following results:
Manual Tests Passed Failed
Buzzer Test
LED Test
Battery Test
MISTIC Test
Auto Test
Inspector
(Name) (Signature)
Facility
Address
City, State, Zip