Hermle Z 130 M, Operating Manual, Page: 19 / 24

III Z 130 M_V1.15 © Hermle Labortechnik GmbH
Redemption form / Decontamination certificate
Decontamination certificate at goods return delivery
Enclose at all returns of equipment and assemblies absolutely!
The completely full declaration about the decontamination is prerequisite for the assumption and further
processing of the return. If no corresponding explanation is enclosed, we carry out decontamination with costs at
your expense.
Surname; last name: _____________________________________
Organization / company: _____________________________________
Street: _____________________________________
ZIP CODE: _____________ place:____________________
Telephone: _____________ fax:____________________
E-Mail: _____________________________________
Pos. Crowd Decontaminated
object
Serial number Description / Comment
1
2
3
4
Are these parts listed above in touch with the following substances?
Health endangering watery solutions, buffers, acids, alkalis:
……….............. .....

Yes

No
Potentially infectious agents
: ………………………………………………………... 
Yes

No
Organic reagents and solvent
: ………………………………...……..................... 
Yes

No
Radioactive substances
: ………………………………………..… 
α
..

β
..

γ
..

Yes

No
Health endangering proteins:
…………………………………….……………......... 
Yes

No
DNA: ………………………………………………………………………………….…. 
Yes

No
These substances have reached the equipment/assembly
? ………………………….. 
Yes

No
Which one, if yes:
________________________________________________________________
Description of the measures for the decontamination of the listed parts:
I confirm the proper decontamination:
Company/dept ._____________ place and date: ____________________________________
Signature of the authorized person: ________________________________________
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