11
Certificate of Decontamination
Type
................................................................................................................................
Order number/
Order item number
6)
................................................................................................................................
Delivery date
................................................................................................................................
Field of application:
................................................................................................................................
Fluid handled
6)
:
................................................................................................................................
Please tick where applicable
6)
:
⃞
⃞
⃞
⃞
radioactive
explosive
corrosive
toxic
⃞
⃞
⃞
⃞
harmful
bio-hazardous
highly flammable
safe
Reason for return
6)
:
................................................................................................................................
Comments:
................................................................................................................................
................................................................................................................................
The submersible mixer/accessories have been carefully drained, cleaned and decontaminated inside and outside prior to
dispatch/placing at your disposal.
⃞
No special safety precautions are required for further handling.
⃞
The following safety precautions are required for flushing fluids, fluid residues and disposal:
...............................................................................................................................................................
...............................................................................................................................................................
We confirm that the above data and information are correct and complete and that dispatch is effected in accordance with
the relevant legal provisions.
....................................................................
.......................................................
.......................................................
Place, date and signature
Address
Company stamp
6)
Required fields
11 Certificate of Decontamination
Amamix® direkt
49 of 52
Goodnal STP ST041 Biological Treatment (KSB Amamix Direct Installation and Operation Manual) Vendor Manual
Q-Pulse Id VM385
Active 29/10/2013
Page 49 of 52