CERTIFICATION OF DECONTAMINATION:
We cannot accept for service or credit a product that has been exposed to or
contaminated with chemically or biologically toxic or infectious substances or subjected
to radioactivity without first being certified as free from said contamination.
Please have your Medical and/or Safety Officer sign this form certifying that
proper decontamination procedures have been followed to render the product safe and
free from hazards.
Any product forwarded to us which is not accompanied by this form and a proper
Return Goods Authorization Number will be returned to the sender. To obtain Return
Goods Authorization Number, contact: Customer Relations Department at 1-800/522-
5463.
We hereby certify that the LAB-LINE INSTRUMENTS, INC. product:
Model No. and Serial No. ,
which is being forwarded has been properly decontaminated and is free from all toxic hazards,
infectious agents, radioactivity and/or other hazards.
Company/Institution Name:
Street Address:
City: State Zip
Name (please print): Title
Signature:
Phone:
DECONTAMINATION PROCEDURE (Be Specific):
Nature of Hazard That Required Decontamination:
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