11 Certificate of Decontamination
Type ................................................................................................................................
Order number/
Order item number
19)
................................................................................................................................
Delivery date ................................................................................................................................
Field of application: ................................................................................................................................
Fluid pumped
19)
:
................................................................................................................................
Please tick where applicable
19)
:
Radioactive Explosive Corrosive Toxic
Harmful Bio-hazardous Highly flammable Safe
Reason for return
19)
:
................................................................................................................................
Comments: ................................................................................................................................
................................................................................................................................
The product/accessories have been carefully drained, cleaned and decontaminated inside and outside prior to dispatch/
placing at your disposal.
We hereby declare that this product is free from hazardous chemicals, biological or radioactive substances.
On seal-less pumps, the rotor has been removed from the pump for cleaning.
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 effected in accordance with
the relevant legal provisions.
.................................................................... ....................................................... .......................................................
Place, date and signature Address Company stamp
19)
Required fields
11 Certificate of Decontamination
UPA, UPZ, BSX
61 of 64
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