INFICON LDS3000 Modular Leak Detector - Manual (Page 51)

Appendix 51
9.2 Declaration of Contamination
INFICON GmbH
Bonner Str. 498,50968 Cologne, Germany
Tel: +49 221 3474 2222 Fax: +49 221 3474 2221
www.inficon.com [email protected] zisa01e1-a
Declaration of Contamination
Legally binding declaration:
I/we hereby declare that the information on this form is complete and accurate and that I/we will assume any further costs that may
arise. The contaminated product will be dispatched in accordance with the applicable regulations.
O rganization/company
Address Post code, place
Phone Fax
Email
Name
Date and legally binding signature Company stamp
1) or not containing any amount
of
hazardous residues that
exceed the permissible ex-
posure limits
Process related contamination of product:
toxic no 1) yes
caustic no 1) yes
biological hazard no yes 2)
explosive no yes 2)
radioactive no yes 2)
other harmful substances no 1) yes
The service, repair, and/or disposal of vacuum equipment and components will only be carried out if a correctly completed declaration has
been submitted. Non-completion will result in delay.
This declaration may only be completed (in block letters) and signed by authorized and qualified staff.
Copies:
Original for addressee - 1 copy for accompanying documents - 1 copy for file of sender
Harmful substances, gases and/or by-products
Please list all substances, gases, and by-products which the product may have come into contact with:
Trade/p roduct name Chemical name
(or symbol) Precautions associated
with substance Action if human contact
Description of product
Type
Article
Number
Serial Number
Reason for return
Operating fluid(s) used (Must be drained before shipping.)
The product is free of any sub-
stances which are damaging to
health yes
This form can be downloaded
from our website.
2) Products thus contami-
nated will not be ac-
cepted without written
evidence of decontami-
nation!