11 Certificate of Decontamination
47 of 50
8417.8/20-EN
11 Certificate of Decontamination
Type:
................................................................................................................................
Order number/
Order item number
11)
:
................................................................................................................................
Delivery date:
................................................................................................................................
Field of application:
................................................................................................................................
Fluid handled
11)
:
................................................................................................................................
Please tick where applicable
11)
:
⃞
⃞
⃞
⃞
⃞
Corrosive
Oxidising
Flammable
Explosive
Hazardous to health
R
⃞
⃞
⃞
⃞
⃞
Seriously hazardous to
health
Toxic
Radioactive
Hazardous to the
environment
Safe
Reason for return
11)
:
................................................................................................................................
Comments:
................................................................................................................................
................................................................................................................................
The product/accessories have been carefully drained, cleaned and decontaminated inside and outside prior to dispatch/
placing at your disposal.
We herewith declare that this product is free from hazardous chemicals and biological and radioactive substances.
⃞
No special safety precautions are required for further handling.
⃞
The following safety precautions are required for flushing fluids, fluid residues and disposal:
...............................................................................................................................................................
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We confirm that the above data and information are correct and complete and that shipping is effected in accordance with the
relevant legal provisions.
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.......................................................
.......................................................
Place, date and signature
Address
Company stamp
11
Required fields
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