Measurement Devices Yes No (if No skip this section) Yes No (if No skip this section) Certification Required Manufacturer Model/Part Description ID Number on Cert Expiration Unit shipped prior to Expiration Cert Attached Number date Date (yes/No) (Yes/No) Machinery Certification/DoC/DoI Applicable Yes No (if No skip this section) Manufacturer Machinery Description Certificate/ DoC/DoI Signed (yes/no) Expiration Date Unit shipped prior Cert Attached to Expiration Date (Yes/No) Model/Part (2006/42/EC, etc.) (Yes/No) Number Other Certification Certificates Model/Part Certificate Standards Met ID Number on Expiration Date Shipped Certified Body Product markings (Ex Manufacturer Number Name (Identified in Cert Date *required to ship Listed on Cert. d IIC T4, etc) Cert) prior to expiration Required Declaration I declare that all referenced documents are complete and meets the requirements identified by GE’s drawing and specifications. I also declare that this TRS compliance summary is complete and represents the equipment listed. Signature Date
Measurement Devices Yes No (if No skip this section) Certification Required Yes No (if No skip this section) Manufacturer Model/Part Number Description ID Number on Cert Expiration date Unit shipped prior to Expiration Date (yes/No) Cert Attached (Yes/No) Machinery Certification/DoC/DoI Applicable Yes No (if No skip this section) Manufacturer Machinery Model/Part Number Description Certificate/ DoC/DoI (2006/42/EC, etc.) Signed (yes/no) Expiration Date Unit shipped prior to Expiration Date (Yes/No) Cert Attached (Yes/No) Other Certification Certificates Manufacturer Model/Part Number Certificate Name Standards Met (Identified in Cert) ID Number on Cert Expiration Date Date Shipped *required to ship prior to expiration Certified Body Listed on Cert. Product markings (Ex d IIC T4, etc) Required Declaration I declare that all referenced documents are complete and meets the requirements identified by GE’s drawing and specifications. I also declare that this TRS compliance summary is complete and represents the equipment listed. Signature Date