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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 is free from hazardous chemicals, biological and radioactive
substances:
Product type: ________________________________
Model number: _____________________________
No media or water: _____________________________
A chemical solution, name: _________________________
(see pump nameplate)
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
GrA3476
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