Endress+Hauser Mycom S CPM 153 Operating Instructions Manual page 136

Declaration of contamination
Dear customer,
Because of legal determinations and for the safety of our employes and operating equipment we need this
"Declaration of contamination" with your signature before your order can be handled. Please put the completely
filled in declaration to the instrument and to the shipping documents in any case. Add also safety sheets and/or
specific handling instructions if necessary.
type of instrument / sensor: __________________________________
medium / concentration:
cleaned with:
:DUQLQJ KLQWV IRU PHGLXP XVHG
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radioactive explosive
Please mark the appropriate warning hints.
5HDVRQ IRU UHWXUQ
&RPSDQ\ GDWD
______________________________
company:
______________________________
______________________________
______________________________
address:
______________________________
______________________________
I hereby certify that the returned equipment has been cleaned and decontaminated acc. to good industrial prac-
tices and is in compliance with all regulations. This equipment poses no health or safety risks due to contamination.
_______________________________
(Date)
More information about services and repairs:
www.services.endress.com
__________________________________
__________________________________
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caustic poisonous
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
serial number: _______________________
temperature: ______ pressure: _______
conductivity: ______ viscosity: _______
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harmful of biological
health hazardous
_________________________
contact person:
_________________________
_________________________
department:
_________________________
phone number:
_________________________
Fax/E-Mail:
_________________________
your order no.:
___________________________________
(company stamp and legally binding signature)
SAFE
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inflammable safe