Thermo Scientific RC 6 Plus Operation Instructions Manual page 75

DECONTAMINATION INFORMATION CERTIFICATE
Complete and attach to equipment BEFORE servicing (instructions on reverse)
DECONTAMINATION
CERTIFIED BY ______________________________________ TITLE/POSITION ____________________________________
PHONE ___________________FAX _____________________ DEPARTMENT ______________________________________
INSTITUTION ______________________________ ADDRESS __________________________________________________
CITY_______________________________________STATE _________________________ZIP ________________________
INSTRUMENT ____________________________________________________ SERIAL NUMBER ______________________
ROTOR _________________________________________________________ SERIAL NUMBER ______________________
PART __________________________________________________________ PART NUMBER _______________________
HAZARDOUS CONTAMINANTS(S)____________________________________ DECONTAMINATION DATE ______________
DECONTAMINATION METHOD(S) _________________________________________________________________________
DECONTAMINATION
CERTIFIER'S SIGNATURE ____________________________________________________DATE ______________________
DECONTAMINATION INFORMATION CERTIFICATE
Complete and attach to equipment BEFORE servicing (instructions on reverse)
DECONTAMINATION
CERTIFIED BY ______________________________________ TITLE/POSITION ____________________________________
PHONE ___________________FAX _____________________ DEPARTMENT ______________________________________
INSTITUTION ______________________________ ADDRESS __________________________________________________
CITY_______________________________________STATE _________________________ZIP ________________________
INSTRUMENT ____________________________________________________ SERIAL NUMBER ______________________
ROTOR _________________________________________________________ SERIAL NUMBER ______________________
PART __________________________________________________________ PART NUMBER _______________________
HAZARDOUS CONTAMINANTS(S)____________________________________ DECONTAMINATION DATE ______________
DECONTAMINATION METHOD(S) _________________________________________________________________________
DECONTAMINATION
CERTIFIER'S SIGNATURE ____________________________________________________DATE ______________________
DECONTAMINATION INFORMATION CERTIFICATE
Complete and attach to equipment BEFORE servicing (instructions on reverse)
DECONTAMINATION
CERTIFIED BY ______________________________________ TITLE/POSITION ____________________________________
PHONE ___________________FAX _____________________ DEPARTMENT ______________________________________
INSTITUTION ______________________________ ADDRESS __________________________________________________
CITY_______________________________________STATE _________________________ZIP ________________________
INSTRUMENT ____________________________________________________ SERIAL NUMBER ______________________
ROTOR _________________________________________________________ SERIAL NUMBER ______________________
PART __________________________________________________________ PART NUMBER _______________________
HAZARDOUS CONTAMINANTS(S)____________________________________ DECONTAMINATION DATE ______________
DECONTAMINATION METHOD(S) _________________________________________________________________________
DECONTAMINATION
CERTIFIER'S SIGNATURE ____________________________________________________DATE ______________________
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