Hirschmann Pipetus Standard, Instruction Manual, Page: 35 / 36

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15. 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 unit 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: