Type
….…………………………………………………………..
Order number/ Order item number
*) ……………………………………………………………..
Delivery date .………………………………………………………………………….
Field of application … ……………………………………………………………………….
Fluid handled
*)
……………………………………………………………..
Please
tick
where applicable
*)
Reason
for
return
*) ……………………………………………………………..
Comments
……………………………………………………………..
……………………………………………………………..
The
pump/accessories have been carefully
drained, cleaned and decontaminated inside and outside
prior to dispatch/placing
at
your
disposal.
On sealless pumps the rotor has been removed from the pump for clearing
.
No
special safety precautions are required for further handling
.
The following safety precautions are required for flushing fluids, fluid residues and disposal
...............................................................................................................................................................
...............................................................................................................................................................
We
confirm that the above data and information
are
correct and complete and that dispatch
is affected
in
accordance with the relevant legal provisions.
............................................................ ………………………………… ………………………………
Place,
date and signature Address Company
stamp
*)
Required fields
To Next Page
Loading...
