7.6.2 Form (for copying) to accompany a returned device
CAUTION!
To avoid any risk for our service personel, this form has to be accessible from outside of the
packaging with the returned device.
Company:
Address:
Department:
Name:
Tel. no.:
Fax no. and/or Email address:
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:
Technology Solutions
Instruction Manual
Tek-Flex
4100A
www.tek-trol.com
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