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Type:
Order number/
Order item number
:
3)
Delivery date:
Applications:
Fluid handled
:
3)
Please tick where applicable
3)
:
⃞
Corrosive
⃞
Seriously hazardous to
health
Reason for return
3)
:
Comments:
The product/accessories have been carefully drained, cleaned and decontaminated inside and outside prior to dispatch/
placing at your disposal.
We herewith declare that this product is free from hazardous chemicals, biological and radioactive substances.
For mag-drive pumps, the inner rotor unit (impeller, casing cover, bearing ring carrier, plain bearing, inner rotor) has been
removed from the pump and cleaned. In cases of containment shroud leakage, the outer rotor, bearing bracket lantern,
leakage barrier and bearing bracket or intermediate piece have also been cleaned.
For canned motor pumps, the rotor and plain bearing have been removed from the pump for cleaning. In cases of leakage at
the stator can, the stator space has been examined for fluid leakage; if fluid handled has penetrated the stator space, it has
been removed.
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
3)
Required fields
42 of 44
10 Certificate of Decontamination
10 Certificate of Decontamination
................................................................................................................................
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................................................................................................................................
................................................................................................................................
................................................................................................................................
⃞
Oxidising
Flammable
⃞
Toxic
Radioactive
................................................................................................................................
................................................................................................................................
................................................................................................................................
.......................................................
Address
4STQ
⃞
⃞
Explosive
⃞
⃞
Bio-hazardous
.......................................................
⃞
Hazardous to health
R
⃞
Safe
Company stamp
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