Leaf User Manual
P/N: 97-4000, Revision 08, Release date: 2020-11-10 Page 84 of 85
Decontamination Certification
Under the provisions of Postal Law, Title 18, United States Code, Section 1716
and Department of Transportation regulations contained in CFR 49, Part
173.386 and
173.387, “etiologic agents, diagnostic specimens and biological
products…are nonmailable…”
The undersigned therefore certifies that the Norlase equipment being returned
herein by
Individual/Institution City, State/Province, Country
Has undergone decontamination with a commercially available germicide cleared for
use as a Hospital Disinfectant and is clean and free from biohazards, including – but
not limited – human or animal blood, tissue or tissue fluids or components thereof.
The undersigned also agrees to reimburse Norlase for any costs incurred in
decontaminating the enclosed equipment, in the event said item is received by
Norlase in a contaminated condition.
Model: Norlase Leaf
Serial Number:
Norlase
RMA Number:
Position/Title:
Name (Printed):
Signature Date (DD/MM/YYYY)
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