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Type
Order number/
10)
Order item number
Delivery date
Field of application:
10)
Fluid pumped
:
10)
Please tick where applicable
⃞
Radioactive
⃞
Harmful
10)
Reason for return
:
Comments:
The product/accessories have been carefully drained, cleaned and decontaminated inside and outside prior to dispatch/
placing at your disposal.
We hereby declare that this product is free from hazardous chemicals, biological or radioactive substances.
On seal-less pumps, the rotor has been removed from the pump for cleaning.
⃞
No special safety precautions are required for further handling.
⃞
The following safety precautions are required for flushing fluids, fluid residues and disposal:
...............................................................................................................................................................
...............................................................................................................................................................
We confirm that the above data and information are correct and complete and that dispatch is effected in accordance with
the relevant legal provisions.
....................................................................
Place, date and signature
10)
Required fields
11 Certificate of Decontamination
11 Certificate of Decontamination
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................
:
⃞
Explosive
⃞
Bio-hazardous
................................................................................................................................
................................................................................................................................
................................................................................................................................
.......................................................
S 100D; UPA 100C
⃞
Corrosive
⃞
Highly flammable
.......................................................
Address
⃞
Toxic
⃞
Safe
Company stamp
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