a) Sources and shieldings are not contaminated
b) The material to be returned has been packed and
labeled according to the regulations (see ADR)
The sender hereby declares that:
Place and Date Signature and Title:
Return of a shielding on loan from sender
Sender's order no.: ........................./ our order confirmation no.
Any other instructions or remarks:
Shielding to be returned to sender after repair
Sender's repair order no.: ........................./ our order confirmation no.
.................................................................................................
.................................................................................................
.................................................................................................
New sources to be inserted in the shielding(s) according to
sender's order no.: ........................./ our order confirmation no.
Shielding to be returned empty to sender
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