Oval ALTI mass CA00A - Safety Statement of Returned Goods

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SAFETY STATEMENT ON RETURNED GOODS
When you return your Coriolis flowmeter for repair or other processing, send us a fax of this Safety
Statement and, at the same time, attach it to the equipment to be returned as we need to provide a safe
working environment for our employees.
Unless the Safety Statement on Returned Goods is attached to the returned equipment, or if we find it
difficult to ensure safety, we may decline, at our discretion, to accept and process the returned equipment.
(In case some residual metered fluid may be present in the housing, consult the factory.)
Model
Serial No.
Process Fluid Names
Health and Safety
Hazards
Precautions
(First aid)
Oval Coriolis Flowmeter ALTI mass
I hereby certify that the equipment being returned has been cleaned and decontaminated in accordance
with good industrial practices. This equipment poses no health or safety risks due to contamination.
Date:
Company Name
Address
Phone No.
Job Title
Signature by
Reason for return
Remarks
Fax No.
List all chemicals and process fluids in contact with the equipment.
If an SDS is available, attach here.
If an SDS is available, attach here.
NOTE: SDS stands for Safety Data Sheet. It informs us of the physical and chemical
properties of materials and how to handle them