96
21. Clearance certificate form
for unit ............................ .......................(Serial number)
Medium used: ..................................................
YES
NO
Please define in case of YES
Blood, bodily fluids, patholog. samples
Other hazardous biologic substances
Biologically-degradable materials which can pose a risk
Chemicals containing substances harmful to health
Radioactive materials
Other hazardous and toxic substances
We hereby declare that
- the until has been carefully cleaned and decontaminated prior to shipment,
- no risks resulting from contamination exist,
- we are aware that liability claims can be made against us in the event of damage being caused by contaminated units.
Address of sender:
Name:
Date:
Signature:
Summary of Contents for Opus Dispenser
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