Vermes MDS 3200A - Declaration Concerning Decontamination of Shipped Equipment

VTK‐VS‐BA‐004e‐B|UserManualMDS3200A | Attachment
75
13.5 DeclarationConcerningDecontaminationofShippedEquipment
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BeforereturningMicrodispensingSystemsforpurposesofinspection,maintenanceandre‐
pair,besurethattheequipmentisinacompletelydecontaminatedstate.Thefollowing
formhastobefilledoutcorrectly;otherwisetheorderwillnotbeprocessed.Uponrequest,
VERMESMicrodispensingperformstherequireddecontaminationafterreceiptof
thecorre‐
spondingsafetydatasheet.Thisworkwillbecalculatedseparately.
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Thisdeclarationmayonlybefilledoutandsignedbyauthorizedandresponsiblepersonnel!
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1.DesignationoftheSystem
SerialNo.:MDVSN#_____________________
 MDVSN#_____________________
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2.LegallyBindingDeclaration
Thesignerdeclaresthatthemicrodispensingsystemisfreeofanysubstancesharmfultohealth.
Thedecontaminatedsystemisshippedaccordingtolegalprescriptions.
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Company:_____________________________________________________________
Address:______________________________________________________________
______________________________________________________________
Name:_______________________________________________________________ 
Phone:_________________________Fax:___________________________________
E‐Mail:________________________________________________________________
Date:_____________________Signature:______ _________________
CompanyStamp:

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3.NoteforShipment
Inordertopreventdamagetotheequipment,themanufacturerrecommendsusingtheorigi‐
nalpackagingmaterialforreturn.Instructionsinchapter0,page66havetobeobserved.The
manufacturerisnotliableforanydamageresultingfrominadequatepackagingortransport.
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