34 Sartoclear
®
Pilot Filter Holder
Appendix
Decontamination Declaration
Declaration Concerning the Decontamination and Cleaning of Equipment and Components
To protect our personnel, we require that all equipment or components which come into contact with our personnel
at customers’ facilities be free of biological, chemical, or radioactive contaminants.
We will only accept an order when:
− the equipment or components have been adequately CLEANED and DECONTAMINATED.
− this declaring document has been completed, signed and returned to us by an authorized person.
Please help us in assuring a safe, hazard-free work environment.
Description of the Equipment or Component(s)
Description | Cat. No.:
Serial no.
No. of invoice | Delivery note:
Date of delivery:
Contamination | Cleaning
Attention: Please specify exactly the biological,
chemical, or radioactive contaminant
Attention: Please describe the cleaning and
decontamination procedure | method.
The equipment was contaminated with:
and it has been cleaned and decontaminated by
Legally binding declaration
I (we) certify that all information given in this form is correct and complete. The equipment and components have
been adequately decontaminated and cleaned according to the legal requirements. No chemical or biological or
radioactive risks remain that could endanger exposed persons’ safety or health.
Company | Institute:
Address | country:
Tel.:
Fax:
Name of authorized person:
Position:
Date | Signature
Please pack the equipment properly and send it ex recipient to your Sartorius service.
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