Declaration of harmlessness
55
© Lutz-Jesco GmbH 2015
Subject to technical changes.
150225
BA-10221-02-V03
Stepper Motor-driven Diaphragm Dosing Pump
MAGDOS LK
Operating Instructions
19 Declaration of harmlessness
Copy the Declaration of harmlessness and complete it separately for each
unit. Enclose one copy to the unit you are sending.
Please send the declaration of harmlessness to us also in advance per fax
or e-mail!
Declaration of no objection
Please fill out a separate form for each appliance!
We forward the following device for repairs:
Device and device type: ................................................................
Part-no.:...................................................................................
Order No.:.....................................................................................
Date of delivery: .......................................................................
Reason for repair: ......................................................................................................................................................................................
..................................................................................................................................................................................................................
..................................................................................................................................................................................................................
Dosing medium
Description: ..................................................................................
Irritating:
Yes
No
Properties: ....................................................................................
Corrosive:
Yes
No
We hereby certify, that the product has been cleaned thoroughly inside and outside before returning, that it is free from hazardous
material (i.e. chemical, biological, toxic, flammable, and radioactive material) and that the lubricant has been drained.
If the manufacturer finds it necessary to carry out further cleaning work, we accept the charge will be made to us.
We assure that the aforementioned information is correct and complete and that the unit is dispatched according to the legal
requirements.
Company / address:......................................................................
Phone:......................................................................................
.....................................................................................................
Fax:..........................................................................................
.....................................................................................................
Email:.......................................................................................
Customer No.:...............................................................................
Contact person:........................................................................
Date, Signature:............................................................................
Summary of Contents for MAGDOS LK
Page 2: ......
