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15. Clearance certificate form
for pipetus
®
................... ..................... (Serial number) Medium used: ..................................................
Yes No Please define in case of YES
Blood, bodily fluids, patholog. samples: o o ___________________________
Other hazardous biologic substances: o o ___________________________
Biologically-degradable materials which can pose a risk: o o ___________________________
Chemicals containing substances harmful to health: o o ___________________________
Radioactive materials: o o ___________________________
Other hazardous and toxic substances: o o ___________________________
We hereby declare that
- the until has been carefully cleaned and decontaminated prior to shipment
- no risks resulting from contamination exist
- we are aware that liability claims can be made against us in the event of damage being caused by contaminated units.
Address of sender:
Name: _______________________________________________________
Date: _______________________________________________________
Signature: _______________________________________________________
pipetus_BA_(D)_(GB)_1005.indd 40pipetus_BA_(D)_(GB)_1005.indd 40 27.10.2005 9:30:01 Uhr27.10.2005 9:30:01 Uhr
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