56
9. Declaration of Contamination
The repair if the instruments can only be accomplished if this document is filled out completely and accurately.
ANSWER by FAX: HOMA Pumpenfabrik GmbH:… +49 (0) 2247 702 - 44
Pump data:
Type:
Part No:
Serial no:
Reason for return:
Contamination of the instruments:
toxic
no □
yes □
substance:
corrosive
no □
yes □
substance:
microbiological
no □
yes □
substance:
explosive
no □
yes □
substance:
radioactive
no □
yes □
substance:
other substances
no □ yes □
substance:
Legally binding declaration:
We hereby certify that the returned parts have been cleaned carefully. To the best of our knowledge, they are free from any residues in dange-
rous quantities.
Company:
Street:
Zip code, City:
Contact person:
Phone:
Fax:
e-mail:
Date
Company stamp and signature
Summary of Contents for Bully C140 WA
Page 15: ...DEUTSCH 15 Notizen Notes ...
