Sonics VCX750 (Serial No."Y through "AB")" - Manual (Page 22)

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SONICS SAFETY CERTIFICATION FORM
Items being returned:
Please check only one item below:
___ The equipment was never used or exposed to any radiological, biological or
chemical agents and is safe to handle, use or dispose of.
___ The equipment was used but not in conjunction with or exposed to any
radiological, geological or chemical agents and is safe to handle, use, or dispose of.
___The equipment was used in conjunction with or exposed to radiological, biological,
or chemical agents and has been decontaminated, rendering it safer for handling, use,
or disposal.
Authorization
By accepting authorization to return the equipment listed above, the undersigned
assumes all responsibility and liability for radiological, biological and chemical
decontamination. Sonics reserves the right to refuse delivery of the equipment without
necessary documentation or where we determine they have not been properly
decontaminated. Sonics reserves the right to bill the customer for any and all costs
associated with the decontamination and/or disposal of the equipment we determine
was not properly decontaminated. In the event the equipment has been exposed to
radiological contamination, the signature of the Radioactive Safety Officer is required.
Print name: ___________________________________ RA # ___________________
Signature: ____________________________________ Date: __________________