Date | : | ____________________ | | Total No. of Pages | : | 10 |
To | : | ____________________ | | Fax | : | _____________ |
Attn | : | ____________________ | | Tel | : | _____________ |
Instructions: Please provide all available information requested below. Return to: Section: | |
Cord Sets & Power Supply Cord Equipment List | |
Applicant Name & Address: | Contact Person: |
| Tel. No.: |
| Fax No.: |
| E-mail: |
Manufacturer Name & Address: | Contact Person: |
| Tel. No.: |
| Fax No.: |
| E-mail: |
For UL Engineer’s or Field Representative’s Use: Inspection Conducted by: File No: E Inspection Date: Project No.: |
Polarization and Continuity Test EquipmentReference: UL 817, Sec. 105 | |||
Criteria | Comply with requirements? | Comments | |
| Yes | No | |
Ohmmeter available | Manufacturer: Model: | ||
Light bulb and battery combination available | |
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