Installation-, Operating-, Maintenance-Manual, Spare Part List
BCR04
AGT-PSG GmbH & Co.KG
Errors and printing mistakes excepted
Page 26
Translation - Manual BCR04 Rev. 6/2017
Return / Maintenance and Repair
Declaration of Contamination Status
Legal regulations prescribe to fill in and sign the declaration of contamination status and send it back.
This information is used to protect our employees. Please attach the declaration to the packing.
Otherwise your repair cannot be processed.
Gevice / Articlenumber / Serialnumber:
Reason for return:
I herewith declare that the device specified above has been properly cleaned and decontaminated and
that there are no risks present when dealing with the device.
In other cases, please describe the hazards in detail:
Explosives
Acute toxicity
Flammable
Oxidizing
Environmental hazard
Corrosive
Irritant toxicity
Health hazard
Liquid
Solid
Powdery
Gaseous
Please include the current material safety data sheet of the hazardous material!
Company,
Contact
Location,
Date,
Stamp,
Signature
