Příloha č. 13
Protokol o kontrole účinnosti zpětného odvodu par
+--------------------------------------------------------+
| čerpací stanice: |
+--------------------------------------------------------+
+---------------------------------------+ +---------------------------------------+
| typ stojanu: | | typ stojanu: |
+---------------------------------------+ +---------------------------------------+
| rok výroby: | | rok výroby: |
+---------------------------------------+ +---------------------------------------+
| stojan č.: | | stojan č.: |
+---------------------------------------+ +---------------------------------------+
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| | | | 50 % | max | | | | | 50 % | max |
| | | | výkon | výkon | | | | | výkon | výkon |
| Pistole | produkt | % | l/min | l/min | | Pistole | produkt | % | l/min | l/min |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A1 | | % | | | | A1 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A2 | | % | | | | A2 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A3 | | % | | | | A3 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A4 | | % | | | | A4 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A5 | | % | | | | A5 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B1 | | % | | | | B1 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B2 | | % | | | | B2 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B3 | | % | | | | B3 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B4 | | % | | | | B4 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B5 | | % | | | | B5 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
+---------------------------------------+ +---------------------------------------+
| typ stojanu: | | typ stojanu: |
+---------------------------------------+ +---------------------------------------+
| rok výroby: | | rok výroby: |
+---------------------------------------+ +---------------------------------------+
| stojan č.: | | stojan č.: |
+---------------------------------------+ +---------------------------------------+
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| | | | 50 % | max | | | | | 50 % | max |
| | | | výkon | výkon | | | | | výkon | výkon |
| Pistole | produkt | % | l/min | l/min | | Pistole | produkt | % | l/min | l/min |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A1 | | % | | | | A1 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A2 | | % | | | | A2 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A3 | | % | | | | A3 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A4 | | % | | | | A4 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| A5 | | % | | | | A5 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B1 | | % | | | | B1 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B2 | | % | | | | B2 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B3 | | % | | | | B3 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B4 | | % | | | | B4 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
| B5 | | % | | | | B5 | | % | | |
+---------+---------+---+-------+-------+ +---------+---------+---+-------+-------+
Datum ..................................... Vypracoval ................................
č. oprávnění .............................. podpis,
razítko
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