Licence Number: No d`homologation: First Issue Date: Premiere

1+
Sante Health
Canada Canada
LN/NH:
Therapeutic Products Directorate
Medical Devices Bureau
Direction des produits therapeutique~
Bureau des materiels medicaux
76023
Licence Number:
76023
No d'homologation:
First Issue Date:
2008/01110
Premiere date de delivrance:
Device Class/Classe de l'instrument: 2
This Licence is issued in accordance with the
Medical Devices Regulations, Section 36,
for the following medical device:
La presente homologation est delivree en vertu
de l'article 36 du Reglement sur les instruments
medicaux pour l'instrument medical suivant:
Licence Name/Nom de l'homologation:
CUSTOM AIR VACUUM EQUIPMENT
Licence Type/Type d'homologation:
Family / Famille
Manufacturer Name & Address/Nom du fabricant & adresse
DENTALEZ ALABAMA INC.
2500 HIGHWAY 31 SOUTH
BAY MINETTE, ALABAMA
UI\lITED STATES
36507
Application Number:
Numero de la demande:
130141
Manufacturer ill:
Identificateur du fabricant:
121617
I
Sante Health
Canada Canada
LN/NH:
Therapeutic Products Directorate
Medical Devices Bureau
Direction des produits therapeutiques'
Bureau des materiels medicaux
76023
Components/Parts/Accessories/Devices for this Licence
Les composantes, parties, accessoires et instruments medicaux pour cette homologation
CUSTOM AIR VACUUM EQUIPMENT
Device IDlNo de l'instrument: 245501
Device Identifier / Identificateur de ('instrument
(Model/Catalog DetaillNo de modele/Catalogue):
CV101 FS
CV1 01 FSW/REC
CV102FS
CV1 02FSW/REC
DUAL WET VACUUM SYSTEM
Device IDlNo de l'instrument: 245502
Device Identifier / Identificateur de I'instrument
(Model/Catalog DetaillNo de modele/Catalogue):
MC201FS
MC201 FSW/REC
MC202FS
MC202FSW/REC
Application Number:
Numero de la demande:
130141
Page 2
Manufacturer ill:
Identificateur du fabric ant:
121617