Declaration of contamination
Dear customer,
Because of legal determinations and for the safety of our employees and operating equipment, we need this
"Declaration of contamination" with your signature before your order can be handled. Please, include the
completely filled in declaration with the device and the shipping documents in any case. Add also safety
sheets and / or specific handling instructions if necessary.
I hereby certify that the returned equipment has been cleaned and decontaminated acc. to good industrial
practices and is in compliance with all regulations. This equipment poses no health or safety risks due to
contamination.
Type of device /sensor:
Serial no.:
Medium / concentration:
Temperature:
Pressure:
Cleaned with:
Conductivity:
Viscosity:
Warning hints for medium used
(mark up the appropriate hints)
radioactive
explosive
caustic
poisonous
harmful to
health
biologically
hazardous
inflammable
safe
Reason for return
:
Company data
Company:
Contact person:
Department:
Address:
Phone:
Fax / e-mail:
Your order no.:
(Place, date)
(Company stamp and legally binding signature)
More information about services and repairs:
www.services.endress.com
SAFE
