32
BG 805 201 BE (9911) QMS200.om
Declaration of contamination
Legally binding declaration:
I hereby declare that the information supplied on this form is complete and accurate. The dispatch of the contaminated product will
be in accordance with the appropriate regulations covering packaging, transportation and labelling of dangerous substances.
Name of organization or company
Address
Post code, place
Phone
Fax
E-Mail
Name
Date and legally binding signature
Company stamp
*)
Products thus conta-
minated will not be
accepted
without
written evidence of
decontamination!
Process related contamination of product:
toxic
no
yes
corrosive
no
yes
biological hazard
no
yes
*)
explosive
no
yes
*)
radioactive
no
yes
*)
other harmful substances no
yes
The repair and/or service of vacuum equipment and components will only be carried out if a correctly completed declaration has been
submitted. Non-completion will result in delay.
This declaration can only be completed and signed by authorized and qualified staff.
Harmful substances, gases and/or by-products
Please list all substances, gases and by-products which may have come into contact with the product:
Trade/product name
manufacturer
Chemical name
(or symbol)
Dangerous
material class Measures if spillage
First aid in case of
contact
Description of product
Type
Article
No.
Serial
No.
Reason for return
Operating fluid(s) used
The product is free of any substances
which are damaging to health yes
Download:
www.pfeiffer-vacuum.de/englisch/infoservice/unbedenk.html
Copies:
Original to manufacturer or representative - 1 copy attach to consignment packaging - 1 copy for file of sender
Содержание Prisma QMS 200
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