Eppendorf Excella E-24R Benchtop Incubator Shakers - Manual (Page 45)

45
New Brunswick Operating Manual
New Brunswick Scientific
Return Authorization and
Decontamination Certificate
Contact Eppendorf for an RMA number prior to returning any equipment, then complete this form and
attach it to the outside container of the equipment being returned to our facility. In addition, please
enclose a completed, duplicate copy of this form with the returned item.
Returned Material Authorization (RMA) Number ____________________
Equipment being returned: Model Number ______________Serial Number__________________
Reason for its return:
______________________________________________________________________________
__________________________________________________________________
This equipment (check all that apply):
New
Product Biohazards
 Never used  Not used
 Used, but decontaminated with
_________________________
Hazardous
Chemicals Radioactive Materials
 Not used  Not used
 Used, but decontaminated with  Used, but decontaminated with
_________________________ _________________________
I certify that the equipment described above has been thoroughly cleaned and
decontaminated of all chemical, biological and radioactive contaminants and also certify
that the returned unit is safe for unprotected human contact.
By: _______________________________ _________________________________
Signature Print name
Title: ______________________________ Date: ____________________________
Company:
____________________________
Address:
____________________________
____________________________
____________________________
Phone:
_________________ Fax: ________________ email: ______________
Form 2847