Yorkshire & the Humber Authorities Verification Service

CERTIFICATE OF CONFORMITY
Liquid Fuel & Lubricant Dispensers
Issued by: Initial Verification Date:………………………..
Yorkshire & the Humber
Authorities Verification Service,
Calibration Test Centre,
Brudenell Way,
Danepark Road,
Hull.
United Kingdom.
HU6 9DX

Submitter

Manufacturer
Type / Model
Serial Number(s)

The Liquid Fuel and Lubricant Dispenser referenced above, having been tested
under the requirements of the Council Directive 2004/22/EC by tests referred to
in OIML R117, is granted EC verification for use in the following place of
installation / location / area of use:

Signature
Print Name
Date
Approved body 0594
number

COPY TO BE RETAINED BY VERIFICATION OFFICER AND APPENDED TO

COMPLETED TEST SHEET
Ref HG/3 1/12/09 – Issue 2 LFMI