F3.09.02 Declaration about Decontamination
Declaration about Decontamination
The service and repair of M. Braun glove boxes and their components can only be performed after presentation of this filled form. The
completed filled declaration must have been checked by M. Braun Service before a part can be accepted. After inspection and approval of
the declaration you will receive a return material authorization number (RMA number).
Note
: The shipment of contaminated parts may be a violation of national and international laws.
Please always fill in general information:
Project number / year of manufacturing:
Type of component:
Type / name / serial number:
Special filters installed in box (e.g. LMF):
Yes
No
Reasons for return:
Please mark in the table below and fill in the reasons. Otherwise complaints cannot be handled properly and maybe only with costs!
Company / Institute:
Street:
ZIP / City:
ONLY FOR ANALYZERS: Order respectively description of error
Pos. Description Applicable Remark
1. Calibration only
No error
1.a. Calibration certificate with initial readings (at cost)
2. Repair desired because of defect (calibration included)
If applicable fill in next lines
2.a. Alarm/warning message: 107/109: “Gas purifier: sensor defective “
2.b. Measurement value does not reach 1.0 ppm
After ____ hours
2.c. Measurement values runs up to _____ ppm and stops at _____ ppm
After ____ hours
2.d.
Reading value varies from ______ to _______
3. Other remarks:
List of hazardous materials and certification of decontamination. Enter all hazardous materials which the component was in
contact with. Please print:
Pos. CAS-No. Name of chemical Chemical formula Class of risk
1.
2.
3.
4.
5.
6.
7.
8.
Hereby we assure that the component has been cleaned and it is not contaminated:
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