Decontamination Declaration - Siemens OXYMAT 64 Operating Instructions Manual

9.4.5

Decontamination declaration

To protect our employees and equipment, it must be guaranteed that all residues of a
medium have been removed from the returned device.
Therefore we check whether a decontamination declaration is present before unpacking the
device.
Please securely apply a clear plastic envelope with the completely filled-in and signed
decontamination declaration including the shipping papers outside on the packaging.
Customer name
Administrator
Delivery address:
Phone/
Fax/
E-mail:
Device name
MLFB No.
Serial number
Description of returned part
Operating duration/
operating date
Confirmation
Location:
Date:
OXYMAT 64
Operating Instructions, 06/2008, A5E00880383-03
Medium
Concentration
Cleaned using
It is herewith confirmed that all residues of the medium have been
removed. The device is therefore free of all dangerous and toxic
materials.
Company, department, name, first name
Signature:
Spare parts and accessories
9.4 Service
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