Ulvac UTM3400 Series Instruction Manual page 101

This is a certificate of decontamination for repair and inspection request of ULVAC Components. All
material must be certified as decontaminated and this certificate must be submitted to your closest local
ULVAC service center or sales office prior to shipment.
Please consult with your closest local ULVAC service center or sales office if our components are used
with toxic gases or contaminated with reactive products or substances produced by reaction.
Product model:
Model:
Serial No.:
Application:
Remarks:
Contaminant (Check an applicable box.)
I guarantee that above returned item(s) is not contaminated with harmful substances.
Above returned item(s) is contaminated with the following harmful substances.
Name of contaminant
1
2
3
4
5
To: ULVAC, Inc
Attn:
Please pack returned item(s) carefully before shipment. Any accident occurred during transportation to
us caused by contaminant is under your responsibility. It is also to be understood that ULVAC may
decline to repair returned item(s) depending on the type of contaminant and degree of contamination, and
return it to you.
To be filled in by ULVAC
Request for MSDS: Yes/No
ULVAC job No.
ULVAC Components / Certificate of Decontamination ULVAC Compone ULVAC Compone ULVAC Compone nts / Certificate of Decontamination nts / Certificate of Decontamination nts / Certificate of Decontamination
(molecular formula)
Your company
Division
Contact
Phone
Fax
E-mail
Form: A003S1268- - - - 04 Form: A003S1268
Form: A003S1268 Form: A003S1268
Characteristics
Date: / /
Received by
04
04 04
(YYYY/MM/DD)