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Type:
Order number /
34)
Order item number
:
Delivery date:
Application:
34)
Fluid handled
:
34)
Please tick where applicable
⃞
Corrosive
⃞
Seriously hazardous to
health
34)
Reason for return:
:
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 and 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
34
Required field
11 Certificate of Decontamination
11 Certificate of Decontamination
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................
................................................................................................................................
:
⃞
Oxidising
⃞
Toxic
Radioactive
................................................................................................................................
................................................................................................................................
................................................................................................................................
.......................................................
Amacan S
⃞
Flammable
Explosive
⃞
Bio-hazardous
Address
⃞
⃞
Hazardous to health
R
⃞
⃞
Safe
.......................................................
Company stamp
123 of 126
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