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Safety declaration
Please copy, fill in and sign this sheet and attach it to the pump returned for service.
We hereby declare that this product:
Product type:____________________________
Model number:_________________________
(see pump nameplate)
is free from hazardous chemicals, biological and radioactive substances.
Fault description
Please make a circle around the damaged part.
In the case of an electrical or functional fault, please mark the cabinet.
Please give a short description of the fault:
_________________ _________________
Date and signature Company stamp
TM02 8953 1104
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