83
15.
14B
Certificate of Contamination
This is a certificate of decontamination for repair and inspection request of ULVAC
Components. All material must be certified as decontaminated and this certificate must be
submitted to your closest local ULVAC service center or sales office prior to shipment.
Please consult with your closest local ULVAC service center or sales office if our components
are used with toxic gases or contaminated with reactive products or substances produced by
reaction.
Product model:
Model:
Serial No.:
Application:
Remarks:
Contaminant (Check an applicable box.)
□
I guarantee that above returned item(s) is not contaminated with harmful substances.
□
Above returned item(s) is contaminated with the following harmful substances.
Name of contaminant
(molecular formula)
Characteristics
1
2
3
4
5
To: ULVAC, Inc
Attn:
Date: / / (YYYY/MM/DD)
Your company
Division
Contact
Phone
Fax
Please pack returned item(s) carefully before shipment. Any accident occurred during
transportation to us caused by contaminant is under your responsibility. It is also to be
understood that ULVAC may decline to repair returned item(s) depending on the type of
contaminant and degree of contamination, and return it to you.
To be filled in by ULVAC
Request for MSDS: Yes/No
Received by
ULVAC job No.
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