Siemens SITRANS SL - Decontamination Declaration; A.5.2 Decontamination Declaration

Appendix
A.5 Returned deliveries
SITRANS SL
204 Operating Instructions, 12/2010, A5E01132948-04
A.5.2 Decontamination declaration
To protect our employees, equipment and environment, it must be guaranteed that the
returned device is free of all residues of the measured media.
For this reason we check if a complete 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.
Name of customer
Person responsible
Delivery address
Phone
Fax
Email
Address for returned delivery
(if different from above)
Device name
Order (MLFB) no.
Serial no.
Designation of returned part
Medium
Concentration
Cleaning medium
Duration of use/
date of commissioning
Confirmation It is herewith confirmed that all residues of the measured
medium have been removed. The device is free of all
dangerous and/or toxic materials.
Location / date /
signature