Appendix
9.4 Declaration of harmlessness
This declaration of harmlessne s s of the operator is used to ensure work safety
and the protection of o ur employees, the transport company and the environment
from harmful effects when handling dangerous materials as well as t o protect you
from claims for compensation.
Every commercial company is obligated to comply with the legal regulations on work
safety, set forth for example in Germany in the Workplace Ordinance (ArbStättV),
the Accident Prevention Regulations (UVV), the Hazardous Substances Ordinance
(GefStoffV) and the applicable environmental regulations.
Please copy this
document and
send it together
with the pump.
www.allweiler.de/
en/sales-service/
downloads
When returning pumps and their accessories, please send them back to us in a properly cleaned condition (safe and harmless
for health and environment) and confirm the safety and harmlessness of the medium used.
If used with toxic, microbiological, explosive, radioactive or other haza rdous substances, the safety d ata sheet must be
provided to us and enclosed to the shipment.
Failure to follow the above instructions will lead to the implementation of measures that ensure the safe handling of the
pump or the de vice, at your cost. We reserve the right to reject contaminated pumps a nd accessories and to return them
forcleaningatyourcost!
This declaration of harmlessness must be attached clearly visible outside of the packaging of the re turn shipment, and if
possible s ent in advance by e-mail including the safety data sheet, if applicable, to:
service-emea-gr@colfaxfluidhandling.com. Please understand that return shipments without a declaration of harmlessness
cannot b e processed until such declaration is received.
Pump type
Serial number:
Was the pump operated with hazardous substance s or other
media that are hazardous to health or the environment?
❏ No
❏ Yes
Medium used:
__________________________________ ____________
UN / CAS number (see safety data sheet):
__________________________________ ____________
❏ The pump has been thoroug hly drained and cleaned outside
and i nside prior to dispa tch or provision.
❏ Special safety precautions are not necessary.
❏ Special sa fety precautions rega rding residual liqu id, rinsing
media, personal protective e qui pment and disposal are
necessary (safety data sheets are required and must be se nt
in advance/enclosed).
❏ Aside from the medium specified, are there any other safety
aspects that need to b e observed (for example, the cleaning
medium used)?
If yes, which:
__________________________________ _____________
❏ U p-to-date safety data sh eet enclosed.
We do not accept return shipment of pumps or parts thereof that have been exposed to radioactive or microbiological
contaminatio n and that were not properly decontaminated.
Contact:
Tel. /fax/e-mail:
Legally binding declaration:
We hereby certify that we have completed this decla r ation fully and truthfully to the best of our knowledge. The dispatch
is performed i n compliance with all legal requirements that apply to the pa ckaging, shipping, and labeling of hazardous
substances. The sender is liable for all damages caused by unmarked decontaminations of the returned o bject.
Place
,date
Signature Stamp
Tab. 24 Declaration of harmlessne s s
40 NIT series BA-2017.03 en-U S 160-282/ 0 – 550 154
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