Thermo Scientific 60-12 Operating And Service Manual page 37

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501 90 Avenue N.W.
Minneapolis, MN 55433
12/9/2008
Please complete all areas of the Decontamination Declaration below.
•
Orders without a Decontamination Declaration will not be processed and the instrument will be returned to the sender
via collect freight.
• Please send this form with a hard copy of your PO to the above email or fax number to obtain an
RMA number for shipping. Retain a copy for your records.
Please provide a specific description of your system's use:
Describe type of product run on your equipment:
____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_____________
Please describe all cleaning and/or decontamination performed:
____________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________
Check all that apply:
Out of Box Failure
Hazardous Materials:
Carcinogen Bacteria
Radioactive Virus
Animal/ Plant/ Mineral (Explain)
___________________________________________
________________________________________________
____________
To the best of my knowledge, this equipment is free of harmful or hazardous chemical, biological or radioactive contamination. I understand
that if the equipment is found to be contaminated, regardless of the signature on this document, the equipment will be returned at my
company's expense.
Signature:
REC 3016 Rev M
DECONTAMINATION FORM
Non-Hazardous Materials only
Fungus
Corrosive
Chem. Hazard
Title:
Hazardous Material
Pathogen
Flammable Chem. Hazard
Other (Explain)
___________________________________________
________________________________________________
____________
Date:
1-800-445-3503
Fax: 763.783.2525
www.thermo.com
(See Below)
Toxic Substance
Reactive Chem.
Hazard
__________
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