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0 <br />�IIBUTORS <br />0 <br />R. UJ. S. DISTRIBUTORS, II1C. <br />P.O. BOX 6325 • SANTA ROSA, CALIFORNIA 95406-6325 <br />1847 FINER ROAD • SANTA ROSA, CALIFORNIA 95403-1990 <br />Order FODnnlber <br />Customer Name _h LA'I s ooh n1 <br />Date Received Serial Number E22084 <br />Accessories received /,US7,ki1a ;)u -T e o5 P 669- Avid <br />Make/Model Number ad i &A42 <br />Visual / Functional check (by e � Z <br />Are there any cracks ormajor damage on the Instrument case? — <br />Is there any corrosion on the circuit boards? No <br />Are any of the sensors leaking? ,V a <br />(noten/a ifuot applicable) <br />Note the EPROM number A-44 <br />Dote the channel set ngs: <br />Chi Ch2 Cha Cho Chs <br />Gas 04, [XL <br />age O21&V J' <br />Alarm 1 /91:!s- /O <br />Alum 2 13_5 SD <br />Alarm 3 <br />Isthednplaywm4=gproperW PHA Yes No - <br />Is the buzzer working properly? N/A Yes No <br />rsthgp,,LF PreFedy? (>=r:@scfh)7N/2r Flow-_L�L_I..Ahmr -- <br />Is <br />Is the data logger working properly? N/A ✓ Yes No <br />E-Mmate given date Approved date Wananty�m ; <br />5--- _ _ t �3A.d rc� 7a fl�s[A�, — -- <br />Remarkst.Malce-sure-aH screws -Are installed _✓ <br />2.Make sure the clips are installed on ribbon. cables ✓ <br />3.Make'sure all,dirt and grime has been removed. from instrument ✓ <br />4 -Attach calibration label and sold and serviced decal sG <br />Iola done by Y� Date <br />AceesseFies-wherrshippect I,uSneuj+vyr 4asT 3, Jtuu-rty✓ 4rn-,i <br />(Instrument reading must be within +S% ojgas concentration to pass) <br />CAILIBRATION CERTNICATION <br />When signed below, BWS Distributors Inc. hereby certifies that this product has been <br />tested, calibrated, inspected and found to meet or exceed all published quality <br />specifications an St ds. <br />Certified by: Date: 0.21,44 <br />Best With Safety Your Full Line Safety Distributor Best With Service <br />TELEPHONE (707) 546-2484 IN CALIFORNIA (800) 862-4685 - FAX (707) 546-4804 <br />