Nor-Cal CDG 100 OP Lit - Manual (Page 37)

CDG100-OP-LIT (2010-1) 37
Declaration of Contamination
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.
Description of product
Type
Part number
Serial number
Reason for return
Legally binding declaration:
We hereby declare that the information on this form is complete and accurate and that we will assume any further costs that may
arise. The contaminated product will be dispatched in accordance with the applicable regulations.
Organization/company
Address Post code, place
Phone Fax
Email
Name
Date and legally binding signature Company stamp
Copies:
Original for addresee - 1 copy for accompanying documents - 1 copy for file of sender
Operating fluid(s) used (Must be drained before shipping.)
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/product name Chemical name
(or symbol) Precautions associated
with substance Action if human contact
The product is free of any sub-
stances which are damaging to
health. yes

Used in copper process
no  yes 
Seal product in plastic bag and
mark it with a corresponding label.
This form can be downloaded
from our website.
2) Products thus contami-
nated
will not be ac-
cepted without written
evidence of decontami-
nation.
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 