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ULTRAZOL®GA9058 (OS634188E) <br />Manufacturer's Affirmative Statement of Compatibility <br />(As required by California Code of Regulations section 2631(k)) <br />(As reauired by Federal Regulation CFR Title 4D (�hnntar 1 4i+hnhnntAr 1 Part7Rn i7 th1ai itim <br />Manufacturer <br />Manufacturer(s) <br />Component <br />Current <br />Unique <br />Supporting <br />Test Data & <br />(including prior <br />Model <br />e <br />Type <br />UL <br />Years of <br />Sizes <br />Identifiers for <br />Blend <br />Documents <br />marketed names) <br />(i.e. pipe, <br />Standard <br />Manufacture <br />Field Evaluation <br />Concentration <br />Attached <br />Nc <br />tank, etc.) <br />Listing <br />C <br />(i.e. color, material) <br />N <br />Yes/No <br />Jomar <br />T -SS -1001 N <br />Ball Vavle <br />YES <br />%11 <br />SS, '/4 turn, <br />Valve <br />100-964yellow <br />handle <br />ru+ ►a++na gnu N+Nn+g Please lis+ urny uuuuie Wali ProauciS <br />Manufacturer: <br />Corporate: <br />Headquarters: <br />Address: <br />Phone: <br />Email: <br />Jomar Valve <br />7243 Miller Dr <br />Warren, MI <br />586-268-1220 <br />csr@jomar.com <br />(Insert a company logo below if available) <br />Glomar <br />VALVE <br />I declare, to the best of my knowledge and belief, that this affirmative statement of compatibility and the information contained herein is true, <br />correct, and complete. <br />Rick Rank Engineering Manager <br />• Print Nam <br />nufacturer's `Authorized Signature <br />Title <br />Date <br />1 /W)04 <br />z <br />n <br />L <br />Nc <br />C <br />7 ^ <br />N <br />1 /W)04 <br />