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Cleaning certificate – YSI 95 User Manual

Page 27

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Warranty and Repair

Section 9

YSI Incorporated

Model 95

23

Cleaning Certificate

Organization ________________________________

Department _________________________________

Address ___________________________________

City _______________ State ______ Zip ________

Country __________________

Model No. of Device ______ Lot Number _________

Contaminant (if known) _____________________

Cleaning Agent(s) used _____________________

Radioactive Decontamination Certified?

(Answer only if there has been radioactive exposure)

___ Yes ___ No

Cleaning Certified By _________________________

Name

Date