Emerson Process Management GmbH & Co. OHG A-17
X-STREAM Non-Incendive
Instruction Manual
HASXENE-IM-EX
12/2014
Because of legal regulations and for the safety of Emerson Process Management employees and
operating equipment, we need this "Declaration of Decontamination", signed by an authorized
person, prior to processing your order. Ensure to include it with the shipping documents, or (re-
commended) attach it to the outside of the packaging.
Instrument details
Analyzer model
Serial no.
Process details
Temperature
Pressure
Please check where applicable, include safety
data sheet and, if necessary, special handling
instructions!
The medium was
used for
Medium and
concentration
CAS No.
toxic harmful corrosive
fl amma-
ble
other
1)
harmless
Process
Process cleaning
Cleaning of
returned parts
1)
e.g. explosive, radioactive, environmentally hazardous, of biological risk, etc.
Declaration and Sender Data
We hereby declare that the retumed parts have been carefully cleaned. To the best of
our knowledge they are free from any residues in dangerous quantities.
Company Contact Person / Function
Address
Phone
Location, Date Signature
A.6 Declaration of Decontamination
A.3 Declaration of Decontamination
A
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