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TG
RADIENT
Manual __________________________________________________________ 34
16 Equipment Decontamination Certificate
To enable us to comply with German law (i.e. §28 StrlSchV, §17 GefStoffV and §19 ChemG) and to avoid
exposure to hazardous materials during handling or repair, will you please complete this form, prior to the
equipment leaving your laboratory
COMPANY / INSTITUTE
____________________________________________________________
ADDRESS
____________________________________________________________
TEL NO
_____________________
FAX NO
_____________________
_____________________
______________________________
EQUIPMENT
Model
Serial No
__________
__________
__________
__________
__________
__________
__________
__________
If on loan / evaluation
Start Date: ________ Finish Date ________
Hazardous materials used with this equipment
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Has the equipment been cleaned and decontaminated? YES / NO (delete)
Method of cleaning / Decontamination
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
NAME ________________________________ POSITION __________________________
(HEAD OF DIV./ DEP./ INSTITUTE / COMPANY)
SIGNED ______________________________ DATE ______________________________
PLEASE RETURN THIS FORM TO BIOMETRA GmbH OR YOUR LOCAL BIOMETRA DISTRIBUTOR
TOGETHER WITH THE EQUIPMENT.
PLEASE ATTACH THIS CERTIFICATE OUTSIDE THE PACKAGING. INSTRUMENTS WITHOUT THIS
CERTIFICATE ATTACHED WILL BE RETURNED TO SENDER.