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GA10218_0101 - 5/2002
1.2 Support from LEYBOLD Ser-
vice
If equipment is returned to Leybold, indicate whether the equipment is
free of substances damaging to health or whether it is contaminated. If it
is contaminated also indicate the nature of the hazard. For this you must
use a form which has been prepared by us which we will provide upon
request or you can take from the technical documentation folder. Also you
will find this declaration on our homepage: www.leybold.com under „sup-
port & download“.
Please attach this form to the equipment or enclose it with the equipment.
This declaration of contamination is required to comply with legal require-
ments and to protect our personal. Leybold must return any equipment
without a declaration of contamination to the sender’s adress.
Before shipping fit the yellow screw-on seals on to the connections
EXHAUST Fig 3/2 and GAS BALLAST Fig 3/3.
Fig. 1 Declaration of contamination form
Declaration of Contamination of Compressors, Vacuum Pumps and Components
The repair and / or servicing of compressors, vacuum pumps and components will be carried out only if a correctly completed declaration has been
submitted. Non-completion will result in delay
. The manufacturer can refuse to accept any equipment without a declaration.
A separate declaration has to be copleted for every single component.
This declaration may be completed and signed only by authorised and qualified staff.
Customer/Dep./Institute : Reason for returning applicable please mark
Address :
repair chargable warranty
exchange chargable warranty
DKD-Calibration Factory Calibration
Person to contact: restoring goods because of following reason:
Phone : Fax: rent/loan for credit against exchange
Order number of customer: exchange already received/arranged
A. Description of the equipment (machine or component) Ancillary equipment
Type :
Catalogue number:
Serial number:
Type of oil used :
B. Condition of the equipment
No Yes No Contamination : No Yes
1
1
.
.
Has the equipment been used
toxic
2. Drained (Product/service fluid)
corrosive
3. All openings sealed airtight
microbiological
4. Purged
explosive
If yes, which cleaning agent
radioactive
and which method of cleaning
other harmful substances
C. Description of processed substances (Please fill in absolutely)
1. What substances have come into contact with the equipment :
Trade name and / or chemical term of service fluids and substances processed, properties of the substances
According to safety data sheet (e.g. toxic, inflammable, corrosive, radioactive)
X Tradename: Chemical name:
a)
b)
c)
d)
Yes No
1. Are these substances harmful ?
2. Dangerous decomposition products when thermally loaded
Which :
Components contaminated by microbiological, explosive or radioactive products will not be accepted without written evidence of
decontamination.
D. Legally binding declaration
I / we hereby declare that the information supplied on this form is accurate and sufficient to judge any contamination level.
Name of authorised person (block letters) :
_______________________________
date signatur of authorised person
firm stamp
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