Appendix
45
Appendix 1
Safety declaration
Please copy, fill in and sign this sheet and attach it to the pump returned for service.
Fault description
Please make a circle around the damaged parts.
In the case of an electrical or functional fault, please mark the cabinet.
Please describe the error/cause of the error in brief.
We hereby declare that the pump has been cleaned and is completely free from chemical, biological and
radioactive substances.
_____________________________________
Date and signature
_____________________________________
Company stamp
Fill in this document using English or German language.
Product type (nameplate)
Model number (nameplate)
Dosing medium
TM04 1185 1110
Dosing liquid has possibly entered the pump housing.
The pump must not be connected to the power supply! Danger of explosion!
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