5323 Highway Avenue
Jacksonville, FL 32254
Phone 904.503.9733
www.reveresurvival.com
LIFERAFT SERVICING CERTIFICATE
Certificate No. 000001
This is to certify this liferaft is in compliance with the inspection requirements of the United States Coast Guard 46 CFR 160.151-57 and in accordance with Revere Survival Inc. servicing manual.
Liferaft Model/Type:
Date of Manufacture:
Vessel/Owner Name:
Liferaft Serial No.
Liferaft Lot No.
Date of Service:
Authorized Service Technician:
Print Name:
Signature:
Place USCG Inspection Sticker Here
Certified Service Station:
Service Station No.
Service - Inspection Report
__________ Raft unpacked, tested and repacked
CO2 Cyl. SN: ______
Hydro Date _________
CO2Wt. ______
NO2Wt. ______
TotalWt. ______
CO2 Cyl. Recharged: ______
Hydrostatically Tested: ______
Sea Light Ass’y: Inner ____
Outer _______
Firing Head: Type _______
SN ________
PRESSURE RELIEF VALVE TESTS
| Relief Valve Upper Tube | Open: | Close: | Pass: |
| Relief Valve Lower Tube | Open: | Close: | Pass: |
AIR RETENTION (WORKING PRESSURE) TEST
| Temp. | Initial Barometer | Pressure | Temp. | Final Barometer | Pressure | Correction | Final | OK | |
| Upper Tube | |||||||||
| Lower Tube |