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CERTIFICATION OF DECONTAMINATION:
We cannot accept for service or credit a product that has been exposed
to or contaminated with chemically or biologically toxic or infectious substances
or subjected to radioactivity without first being certified as free from said
contamination.
Please have your Medical and/or Safety Officer sign this form certifying
that proper decontamination procedures have been followed to render the
product safe and free from hazards.
Any product forwarded to us, not accompanied by this form and a proper
Return Goods Authorization Number, will be returned to the sender. To obtain a
Return Goods Authorization Number, contact the Customer Relations
Department at (800) 522-5463.
We hereby certify that the LAB-LINE INSTRUMENTS, INC. product:
Model No. and Serial No. ,
which is being forwarded has been properly decontaminated and is free from all toxic
hazards, infectious agents, radioactivity and/or other hazards.
Company/Institution Name:
Street Address:
City: State Zip
Name (please print): Title
Signature:
Phone:
DECONTAMINATION PROCEDURE (Be Specific):
Nature of Hazard That Required Decontamination:
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