Certificate Of Decontamination - Heidolph Multifarious Hei-SHAKE Unimax 1010 Operating Instructions Manual

Appendix

Certificate of decontamination

Enclose the certificate of decontamination, duly completed, with your device return.
Submissions without a certificate of decontamination cannot be processed!
CER T IF I C AT E OF
DECO N TA MIN AT ION
I N C A S E O F R E T U R N S
Please fill in the required fields.
Note: The sender must package the goods
properly and appropriately for transport.
SENDER
Name
Company/institution
Address
ZC/City
Country
Email
DEVICE DETAILS
Article number
Ticket number
Reason for sending in
Has the device been cleaned, decontaminated/disinfected?
If yes, which measures were carried out?
Does this device pose a risk to people and/or the environment due
to the processing of substances that are hazardous to health,
the environment and/or are biohazardous?
If yes, with which substances did the device come into contact?
LEGALLY BINDING DECLARATION
The principal/consignor is aware that they are liable to the agent/consignee for losses or damage incurred due to incomplete and
incorrect information.
Date Signature
© Heidolph Instruments GmbH & Co. KG
Doc-ID: 01-006-003-30-2 – Ed.: 2022-11-08
Heidolph Instruments GmbH & Co. KG
Walpersdorfer Straße 12
91126 Schwabach, Germany
Phone: +49 (0) 9122 9920-380
Fax: +49 (0) 9122 9920-19
Email: service@heidolph.de
First name
Department
Workgroup
Phone
Serial no.
Yes No
Yes No
Company stamp
55
(Please mark as applicable)
(Please mark as applicable)