Example Only 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. _______________________________________________________________