5
SERVICE
30
OPTIWAVE 5200 C/F
www.krohne.com
09/2014 - 4001906103 - AD IECEX OPTIWAVE 5200 R03 en
5.3.2 Form (for copying) to accompany a returned device
Company:
Address:
Department:
Name:
Tel. no.:
Fax no.:
Manufacturer's order no. or serial no.:
The device has been operated with the following medium:
This medium is:
radioactive
water-hazardous
toxic
caustic
flammable
We checked that all cavities in the device are free from such
substances.
We have flushed out and neutralized all cavities in the
device.
We hereby confirm that there is no risk to persons or the environment through any residual media
contained in the device when it is returned.
Date:
Signature:
Stamp:
