Appendix
19
Appendix 1
Safety declaration
Please copy, fill in and sign this sheet and attach it to the pump returned for service.
Media and application
Which media has the pump been used for: ______________________
In which application has the pump been used: ____________________
Fault description
If possible please make a circle around the faulty part.
(In case of an electrical fault, please mark the terminal box.)
Please give a short description of the fault:
We hereby declare that this product is free from hazardous chemicals,
biological and radioactive substances.
_________________________ _________________________
Date and signature Company stamp
TM04 0359 1008
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