Address of operator
Place, date, signature
The safety equipment was subjected to a recurring FUNCTION CHECK and worked correctly
at that time.
Place, date
For Switzerland, the following must be observed:
The name of the installation company with on-call service and telephone number must be attached to
DECLARATION OF CONFORMITY
You will find the manufacturer's declaration of conformity for this product
on the website: http//www.gok-online.de/en/certificate/
declaration of conformity.php
DECLARATION OF COMPLIANCE
You will find the manufacturer's declaration of compliance for this product
on the website: http//www.gok-online.de/en/certificate/
declaration of compliance.php. This document also contains the technical
description and appendices 1 and 2 of the ZG-ÜS.
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Installation certificate – page 2
Recurring FUNCTION CHECK
the indicator of the BC-1!
Regler- und Armaturen-Gesellschaft mbH & Co. KG
Obernbreiter Straße 2-16 • 97340 Marktbreit / Germany
Tel.: +49 9332 404-0 • Fax: +49 9332 404-43
E-Mail: info@gok-online.de • Internet: www.gok-online.de
Overfill prevention divice type BC-1
Address of specialised company
Place, date, signature, stamp of the specialised company
Specialised company (stamp, signature)