Form: A00315268-02-00
ULVAC Components / Certificate of Decontamination
This is a certificate of decontamination for repair and inspection request of ULVAC Components. All
material must be certified as decontaminated and this certificate must be submitted to your closest local
ULVAC service center or sales office prior to shipment.
Please consult with your closest local ULVAC service center or sales office if our components are used
with toxic gases or contaminated with reactive products or substances produced by reaction.
Product model:
Model:
Serial No.:
Application:
Remarks:
Contaminant (Check an applicable box.)
I guarantee that above returned item(s) is not contaminated with harmful substances.
Above returned item(s) is contaminated with the following harmful substances.
Name of contaminant
(molecular formula)
Characteristics
1
2
3
4
5
To: ULVAC
Attn:
Date: / / (YYYY/MM/DD)
Your company
Division
Contact
Phone
Fax
Please pack returned item(s) carefully before shipment. Any accident occurred during transportation to
us
and during disassembly
caused by contaminant is under your responsibility. It is also to be
understood that ULVAC may decline to repair returned item(s) depending on the type of contaminant
and degree of contamination, and return it to you.
To be filled in by ULVAC
Request for SDS: Yes/No
Received by
ULVAC job No.
