Declaration Of No Objection - ITT Bornemann SLH-4U Operating Instructions Manual

9.2 Declaration of no objection

Declaration of no objection
Statutory regulations oblige all commercial companies to protect their employees, the public and the environment from the
hazardous effects of dangerous substances.
For this reason, repair and inspection of the products and their parts may only be undertaken once the following declaration
has been correctly and fully filled out and signed by an authorised, qualified engineer.
If safety measures must be employed despite complete emptying and cleaning on the part of the operator, then this required
information must be passed on. This declaration of no objection comprises part of the repair or inspection order.
We hereby declare that the enclosed device
Type:
Serial number:
n is free of hazardous materials. Special safety measures for further handling of the device are not necessary.
n The device has been fully emptied and thoroughly cleaned inside and out prior to dispatch.
The following media was previously conveyed by
the pump:
The medium was hazardous:
The pump was emptied by the operating firm:
The pump was thoroughly cleaned inside and out by the operating firm:
The pump came into contact with hazardous substances:
If yes: Hazardous material number according to Ordi-
nance on Hazardous Substances (GefStoffV):
or CAS registration number (Chemical Abstract Service):
Company/Institute:
Street:
Postcode, city:
Telephone:
Name:
Item:
Date:
Signature,
company stamp:
___________________________________
___________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
03/2020 JP Rev. 1
Please copy and send with the pump.
_______________________________________________
___________________________________________
_________________________________
r YES r NO
r YES r NO
r YES r NO
r YES r NO
Type SLH-4U
Appendix
73