Biometra TGRADIENT 48 - Equipment Decontamination Certificate

TGRADIENT Manual __________________________________________________________ 34

16 Equipment Decontamination Certificate

To enable us to comply with German law (i.e. §28 StrlSchV, §17 GefStoffV and §19 ChemG) and to avoid

exposure to hazardous materials during handling or repair, will you please complete this form, prior to the

equipment leaving your laboratory

COMPANY / INSTITUTE ____________________________________________________________

ADDRESS ____________________________________________________________

TEL NO _____________________ FAX NO _____________________ E-MAIL _____________________

______________________________

EQUIPMENT Model Serial No

__________ __________

If on loan / evaluation Start Date: ________ Finish Date ________

Hazardous materials used with this equipment

_________________________________________________________________________________

Has the equipment been cleaned and decontaminated? YES / NO (delete)

Method of cleaning / Decontamination

_________________________________________________________________________________

NAME ________________________________ POSITION __________________________

(HEAD OF DIV./ DEP./ INSTITUTE / COMPANY)

SIGNED ______________________________ DATE ______________________________

PLEASE RETURN THIS FORM TO BIOMETRA GmbH OR YOUR LOCAL BIOMETRA DISTRIBUTOR

TOGETHER WITH THE EQUIPMENT.

PLEASE ATTACH THIS CERTIFICATE OUTSIDE THE PACKAGING. INSTRUMENTS WITHOUT THIS

CERTIFICATE ATTACHED WILL BE RETURNED TO SENDER.