3 Declaration of media in contact
with the micro annular gear pump and its components
Instruction for startup/shutdown
Last update: March 2015
Technical data subject to change without prior notice!
10
3
Declaration of media in contact
with the micro annular gear pump and its components
Type of the device
Pump type/serial number/article: ....................................................................................................
Operating hours/running time: ......................................................................................................
Bill of delivery-number and delivery date: ......................................................................................
Reason of the return: ....................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
Contact with media (liquids)
The micro annular gear pump has entered into contact with: ........................................................
......................................................................................................................................................
and has been cleansed with: .........................................................................................................
......................................................................................................................................................
The safety specification of the liquid has been attached (Yes / No): ..............................................
or is available on the following web site: www.............................................................................
If a pump which had contact with dangerous substances could not be properly cleansed prior to
the shipment, we reserve the right to entrust a specialized company with the cleansing of the
device. The return of the pump in the original packing is purposive. This measure is necessary in
order to protect the employees and the delivery staff.
Nature of the delivered liquid:
explosive
toxic (toxic byproducts)
carcinogenic
caustic
oxidizing
radioactive
microbiological
corrosive
susceptible to moisture
pH-value:
...................................................
other:
.........................................................
Declaration
I/we certify herewith that the stated information is exhaustive and correct. The micro annular gear
pump and corresponding liquid supply components are shipped in conformity with the applicable
regulations.
Company/Institute: ........................................................................................................................
Street: .............................................................. Zip code, location: ..............................................
Telephone: ........................................................ Fax: ....................................................................
Contact person (in printed characters): ..........................................................................................
Date: ................................................................ Company stamp: ................................................
Obligatory signature: .....................................................................................................................
