BioProTT
TM
Flow Measurement System
Version 1.00
page 72 of 75
15
Return Information and
Declaration of Contamination
Because of legal regulations and for the safety of our employees and operating equipment, we need the
"Declaration of Contamination", with your signature, before your order can be handled. Please make
absolutely sure to include it with the shipping documents, or - even better - attach it to the outside of the
packaging.
Type of device, e.g. flow meter, sensor
_________________
Serial number
_______________
Relevant process data
Temperature / _________ [°C]
Pressure / __________ [ Pa ]
Conductivity / _________ [ S ]
Viscosity / __________ [mm /s]
Medium and warnings
Medium /
concentration
Identi-
fication /
CAS No
Flammable
Toxic
Corrosive
Harmful/
Irritant
Other*
Harmless
Process
Medium
Medium for
process
cleaning
Returned
part cleaned
with
* explosive; oxidizing; dangerous for the environment; biological risk; radioactive
Please tick should one of the above be applicable, include security sheet and, if necessary, special handling
instructions.
Reason for return:
Company contact data:
Company:
Contact person/department:
Address:
Fax / E-Mail
Reference No:
We hereby certify that the returned parts have been carefully cleaned. To the best of our knowledge they are
free from any residues in dangerous quantities.
_______________________________
__________________________________
(Place, Date)
(Company stamp and signature)
