Appendix
- 47 -
optek-sensors AS56, Version 04.2010_1.2US, 15.04.2010
www.optek.com
Decontamination declaration
Sensor type /
Sensor body
type
Ser. No.
Process data
Temperature [°C] [°F] Pressure [bar] [psi]
Conductivity [µS/cm] Viscosity
[mm
2
/s]
[cp]
Concentration
of medium
Identification
CAS No.
Possible risks
(Please tick corresponding symbol
and add the safety data sheet, if necessary)
flammable
harmful /
irritating
toxic
corrosive
biological risk
other
risk
harmless
Process medium
Cleaning
medium
for process
cleaning
Cleaning
medium of
sensor
Description of
fault
of component
Sender
Company
Contact person Phone
Address
Fax
The signatory hereby certifies that this decontamination declaration is filled out truthfully and completely to the best of his knowledge.
He further certifies that the returned components have been cleaned carefully and that, to the best of his knowledge, they are free of
any residues in dangerous quantities.
________________________ _____________________ ________________________ _______________________
Place Date Name of the signatory
in block letters
Signature
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