Appendix
39
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
Product type (nameplate)
Model number (nameplate)
Dosing medium
TM04 1185 1110
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