Fig. 1 Declaration of Contamination
Declaration of Contamination
Legally binding declaration:
I/we hereby declare that the information on this form is complete and accurate and that I/we will assume any further costs that may
arise. The contaminated product will be dispatched in accordance with the applicable regulations.
Organization/company
Address Post code, place
Phone Fax
Email
Name
Date and legally binding signature Company stamp
1) or not containing any amount
of hazardous residues that
exceed the permissible ex-
posure limits
Process related contamination of product:
toxic no
1) yes
caustic no
1) yes
biological hazard no
yes
2)
explosive no
yes
2)
radioactive no
yes
2)
other harmful substances no
1) yes
The service, repair, and/or disposal of vacuum equipment and components will only be carried out if a correctly completed declaration has
been submitted. Non-completion will result in delay.
This declaration may only be completed (in block letters) and signed by authorized and qualified staff.
Copies:
Original for addressee - 1 copy for accompanying documents - 1 copy for file of sender
Harmful substances, gases and/or by-products
Please list all substances, gases, and by-products which the product may have come into contact with:
Trade/product name
Chemical name
(or symbol)
Precautions associated
with substance
Action if human contact
Description of product
Type
Article Number
Serial Number
Reason for return
Operating fluid(s) used (Must be drained before shipping.)
The product is free of any sub-
stances which are damaging to
health yes
This form can be downloaded
from our website.
2) Products thus conta mi-
nated will not be ac-
cepted without written
evidence of deconta mi-
nation!
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