THERMOSTATIC MIXING VALVE CERTIFICATE

ESTABLISHMENT: NAME____________________________________________________
ADDRESS_________________________________________________
ATTENTION__________________________________________________
VALVE/Make/Model_____________________________________________________
No. of POINTS served______________ Size of Valve___________mm.
Static HOT Pressure________K.P.A. Static COLD Pressure__________K.P.A.
Temp. at hot inlet___________ Temp. at cold inlet______
Temp.at mixed outlet________
Does THERMAL SHUT DOWN Function Yes/ No Number of Valves on site________
Date of last service ___________________Date of this service___________
I hereby certify that the service carried out on this valve was done with strict accordance with the valve manufacturers requirements.
SIGNED_______________________________________________________(Lic. Plumber)
Print NAME____________________________________________________(Lic. Plumber)
I have witnessed the above information and believe it to be true and correct
SIGNED_________________________________________________________
Print NAME_______________________________________________________
ROLE ition)_______________________________________________________
DATE___________________________________________________________
Description of WORK carried out: _______________________________________________________________
LOCATION OF VALVE: I.D. Number. _______________________________________________________________