MTS Sensors Temposonics V R Series Operation Manual page 43

13. Appendix I
Safety Declaration Safety Declaration
Dear Customer, Dear Customer,
If you return one or several sensors for checking or repair, we need you to sign a safety declaration. The purpose of this declaration is to ensure If you return one or several sensors for checking or repair, we need you to sign a safety declaration. The purpose of this declaration is to ensure
that the returned items do not contain residues of harmful substances and / or that people handling these items will not be in danger. that the returned items do not contain residues of harmful substances and / or that people handling these items will not be in danger.
MTS Sensors order number: ________________________________ MTS Sensors order number: ________________________________
Serial number(s): _________________________________________ Serial number(s): _________________________________________
The sensor has been in contact with the following materials: The sensor has been in contact with the following materials:
Do not specify chemical formulas. Do not specify chemical formulas.
Please include safety data sheets of the substances, if applicable. Please include safety data sheets of the substances, if applicable.
Short description of malfunction: Short description of malfunction:
Corporate information Corporate information
Company: _______________________________________________ Company: _______________________________________________
Address: _______________________________________________ Address: _______________________________________________
_______________________________________________________ _______________________________________________________
We hereby certify that the measuring equipment has been cleaned and neutralized. We hereby certify that the measuring equipment has been cleaned and neutralized.
Equipment handling is safe. Personnel exposure to health risks during transport and repair is excluded. Equipment handling is safe. Personnel exposure to health risks during transport and repair is excluded.
Stamp Stamp
GERMANY GERMANY
MTS Sensor Technologie MTS Sensor Technologie
Tel. + 49 - 23 51- 95 87 0 Tel. + 49 - 23 51- 95 87 0
GmbH & Co.KG GmbH & Co.KG Fax. + 49 - 23 51- 5 64 91 Fax. + 49 - 23 51- 5 64 91
Auf dem Schüffel 9 Auf dem Schüffel 9 info.de@mtssensors.com info.de@mtssensors.com
58513 Lüdenscheid, Germany 58513 Lüdenscheid, Germany www.mtssensors.com www.mtssensors.com
Sensor type(s): __________________________________________ Sensor type(s): __________________________________________
Sensor length(s): ________________________________________ Sensor length(s): ________________________________________
In the event of suspected penetration of substances into the sensor, In the event of suspected penetration of substances into the sensor,
consult MTS Sensors to determine measures to be taken before consult MTS Sensors to determine measures to be taken before
shipment. shipment.
Contact partner Contact partner
Name: Name:
Phone: Phone:
E-mail: E-mail:
Signature Signature
USA USA
MTS Systems Corporation MTS Systems Corporation
Tel. +1 919 677-0100 Tel. +1 919 677-0100
Sensors Division Sensors Division
Fax +1 919 677-0200 Fax +1 919 677-0200
3001 Sheldon Drive 3001 Sheldon Drive info.us@mtssensors.com info.us@mtssensors.com
Cary, N.C. 27513, USA Cary, N.C. 27513, USA www.mtssensors.com www.mtssensors.com
_______________________________________________ _______________________________________________
_______________________________________________ _______________________________________________
_______________________________________________ _______________________________________________
Date Date