Declaration Of Contamination - Pfeiffer Vacuum OmniStar GSD 300 O1 Operating Manual

Declaration of Contamination

The repair and/or service of vacuum equipment and components will only be carried out if a correctly completed declaration has been
submitted. Non-completion will result in delay.
This declaration can only be completed and signed by authorised and qualified staff.
Description of product
Type
Article No.
Serial No.
Harmful substances, gases and/or by-products
Please list all substances, gases and by-products which may have come into contact with the product:
Trade/Product name
Manufacturer
Legally binding declaration:
I hereby declare that the information supplied on this form is complete and accurate. The dispatch of the contaminated product will
be in accordance with the appropriate regulations covering packaging, transportation and labelling of dangerous substances.
Name of organisation or company
Address
Phone
E-Mail
Name
Date and legally binding signature
Copies: Original to manufacturer or representative - 1 copy attach to consignment packaging - 1 copy for file of sender
38 Appendix
Reason for return
Operating fluid(s) used
Process related comtamination of product:
toxic
corrosive
biological hazard
explosive
radioactive
other harmful substances
Dangerous
Chemical name
material class Measures if spillage
(or symbol)
Post code
Telex
Company stamp
q q
no yes
q q
no yes
q q
no yes *)
q q
no yes *)
q q
no yes *)
q q
no yes
*) Products thus conta-
minated will not be
accepted without
written evidence of
decontamination!
First aid in case of
human contact
BG 805 071 BE (9904) OmniStar™ ThermoStar™