Vermes MDS 358X - Declaration Concerning Decontamination of Shipped Equipment

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VTK-TR-BA-072e-1 - User Manual MDS 358X Series
14.8 Declaration Concerning Decontamination of Shipped Equipment
Before returning Microdispensing Systems for purposes of inspection, maintenance and repair,
be sure that the equipment is in a completely decontaminated state. You have to fill out the
following form correctly; otherwise, the order will not be processed. Upon request, VERMES
Microdispensing performs the required decontamination after receipt of the corresponding
safety data sheet. This work will be calculated separately.
Only authorized and responsible personnel may fill out and sign this declaration!
1 Designation of the System
Serial No.:
MDV SN# _____________________________
MDV SN# _____________________________
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.
Company: _________________________________________________________________________
Address: __________________________________________________________________________
__________________________________________________________________________
Name: ____________________________________________________________________________
Phone: __________________________________
Fax:___________________________________
E-Mail: ____________________________________________________________________________
Date: ____________________________________
Signature: _____________________________
Company Stamp:
3 Note for Shipment
In order to prevent damage to the equipment, the manufacturer recommends using the original
packaging material for return. Instructions about transport have to be observed (see paragraph 12.1,
page 155). The manufacturer is not liable for any damage resulting from inadequate packaging or
transport.