Jevatec JEVAmet, Инструкция по эксплуатации

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JEVATEC
Ideen in der Vakuumtechnik
Declaration of Contamination FB6001
EN
Seite
1 von 2
The repair and / or servicing of articles of the vacuum engineering (vacuum measuring instruments, vacuum pumps and
vacuum components) will be carried out only if a correctly completed declaration has been submitted. Non-completion
will result in delay. The manufacturer can refuse to accept any equipment without a declaration. A separate declaration
has to be completed for each single article.
For diagnosis and shipping by JEVATEC costs will be incurred. Please
consider also the safety information on the back of this declaration!
This declaration may be completed and signed only by authorized and qualified staff.
1. Description of the article: 2. Reason of Return:
Equipment type:
Code No.:
Serial No.:
Invoice No.:
Delivery Date:
3. Condition of the Article: 4. Process related Contamination of Article:
Has the article been used? yes no toxic yes no
What kind of oil / liquid was used? corrosive
yes no
microbiological*) yes no
Is the equipment free from potentially harmful
substances?
explosive*)
yes no
radioactive*) yes no
yes go to 5. no go to 4.
other harmful substances
yes no
*) Articles which have been contaminated by biological, explosive or radioactive substances will not accepted without written evidence of decontamination!
All subtances, gases and by-products which may have come into contact with the equipment:
Trade Name
Product Name
Manufacturer Chemical Name
(chemical formula)
Hazard
Group
Measures when harmful
substances are released
First Aid
for accidents
5. Legally Binding Declaration:
I hereby declare that the information supplied on this form ist complete an accurate. The despatch of the contaminated
articles will be accordance with the appropriate regulations covering, packaging, transportation and labeling of
dangerous substances.
Company:
Street, No.: Phone:
Zip Code, City: Fax:
Name: E-mail:
Date, Signature: Stamp: