SAFETY
SHEET
34
519924.03
ANNEX
A
vacuum
pump
and
its
accessories
may
in
some
cases
draw
up
or
be
in
contact
with
hazardous
substances.
For
reasons
of
safety
of
the
staff
or
our
after
sales
and
repair
departments,
and
in
accordance
with
the
regulations,
it
is
mandatory
that
you
complete
this
form
with
the
following
essential
information
when
returning
the
equipment
to
the
factory
for
repair
.
Otherwise,
the
products
received
will
be
isolated
in
a
quarantine
area
and
no
human
intervention
may
be
undertaken.
Machine
type:
……………………………………………
Serial
no.:
…………………………………………….
Date
of
sending:
……………………………………………
Cause
for
return
:
……………………………………………
ESSENTIAL
INFORMATION
What
type
of
oil
is
used
for
the
pump:
Presence
of
bacteriological
filtration:
YES
NO
Presence
of
bacteriological
cartridge:
YES
NO
Does
the
device
contain
toxic
substances:
YES
NO
Does
the
device
contain
corrosive
substances:
YES
NO
Does
the
device
contain
CMR*
substances:
YES
NO
Does
the
device
contain
explosive
substances:
YES
NO
Does
the
device
contain
radioactive
substances
:
YES
NO
Others:
............................................................................................
YES
NO
(*)
CMR
:
carcinogenic
‐
mutagenic
‐
reprotoxic
If
radioactive
or
explosive
materials
are
present,
list
the
substances
of
the
gas
and
the
by
‐
products:
Product
name
Chemical
Risk
category
First
aid
Legal
declaration
We
declare
on
our
honour
that
the
data
in
this
declaration
was
provided
exhaustively,
sincerely
and
factually
and
that
the
undersigned
is
qualified
to
judge
this.
We
are
aware
that
we
are
liable
in
relation
to
the
contractor
for
incomplete
or
incorrect
data.
We
commit
ourselves
to
exempt
the
contractor
from
any
responsibility
in
relation
to
third
parties
in
respect
of
damage
and
interests
owed
to
incomplete
or
incorrect
data.
We
are
aware
that
beyond
this
declaration,
our
responsibility
is
directly
engaged
in
relation
to
third
parties,
which
includes
in
particular
the
employees
of
the
contractor
responsible
for
handling/repairing
the
product.
Company:
...................................................................
Postal
code/City:
...............................................................
Street:
.........................................................................
Fax:
....................................................................................
Name
(in
capital
letters):
............................................
Position:
...........................................................................
Telephone:
.................................................................
Company
seal:
.................................................................
Date:
Signature:
