Thermo Scientific APEX 100 User Manual page 268

Decontamination Declaration Form
Please complete all parts of the decontamination declaration form. In addition, please note the following.
• Orders without a completed decontamination declaration form will not be processed, and the equipment
will be returned to the sender via collect freight.
• Please send this decontamination declaration form with a hard copy of your purchase order (PO) to the fax
number or email address in the "Contacting Thermo Fisher Scientific" section at the end of the manual.
Please retain a copy of this decontamination declaration form for your records.
System Description
Please provide a detailed description of your system, equipment, and the type of product analyzed.
Decontamination Procedures Already Performed
Please describe all cleaning and other decontamination procedures already performed on the equipment you
are returning.
Check All That Apply

Out-of-box failure
Hazardous Materials

Carcinogen/pathogen

Corrosive/flammable/reactive chemical hazard

Animal/plant/mineral
Explain

Other
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 or may be subject to an
additional decontamination fee of $300.
Signature
Title
Page 268

Non-hazardous materials only

Fungus/virus/bacteria
Date

Hazardous material (see below)

Toxic/radioactive
Thermo Scientific APEX User's Guide