Installation-, Operating-, Maintenance-Manual, Spare part List MAK10
AGT-PSG GmbH & Co.KG
Errors and printing mistakes excepted
Page 32
Translation - Manual MAK10 Rev. 11/2017
Return / Maintenance and Repair
Declaration of Contamination Status
Legal regulations prescribe to fill in and sign the declaration of contamination status and send it back.
This information is used to protect our employees. Please attach the declaration to the packing.
Otherwise your repair cannot be processed.
Device / Articlenumber / Serialnumber:
Reason for return:
I herewith declare that the device specified above has been properly cleaned and decontaminated and
that there are no risks present when dealing with the device.
In other cases, please describe the hazards in detail:
Explosives Acute toxicity Flammable Oxidizing
Environmental hazard Corrosive Irritant toxicity Health hazard
Liquid Solid Powdery Gaseous
Please include the current material safety data sheet of the hazardous material!
Company, Contact Location, Date, Stamp, Signature