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Siemens OXYMAT 64 - Decontamination Declaration

Siemens OXYMAT 64
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Spare parts and accessories
9.4 Service
OXYMAT 64
Operating Instructions, 06/2008, A5E00880383-03
127
9.4.5 Decontamination declaration
To protect our employees and equipment, it must be guaranteed that all residues of a
medium have been removed from the returned device.
Therefore we check whether a decontamination declaration is present before unpacking the
device.
Please securely apply a clear plastic envelope with the completely filled-in and signed
decontamination declaration including the shipping papers outside on the packaging.
Customer name
Administrator
Delivery address:
Phone/
Fax/
E-mail:
Device name
MLFB No.
Serial number
Description of returned part
Medium
Concentration
Cleaned using
Operating duration/
operating date
Confirmation It is herewith confirmed that all residues of the medium have been
removed. The device is therefore free of all dangerous and toxic
materials.
Location:
Company, department, name, first name
Date: Signature:

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