LLG uni VACUUPUMP1 Manual De Instrucciones página 31

Company / Facility
Street
Post Code / Town
1. Description of the fault:
2. Conditions of use:
oil
Field of application
3. Type of contamination of pumps / components:
1)
1)
1)
1)
1)
* In the case of rotary vane pumps
and roots pumps (Important!)
Type(s) of substances or process-related reaction products which came into contact with the pumps/ components:
Are the pumps / components free of harmful substances?
4. Legally binding declaration:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Legally binding signature:
1)
Answer all questions or mark with • • • • yes or • • • • no. If a box is not filled out, we automatically suppose that there was a contamination and
the required measures are charged to you.
Order No.:
Type No.:
Type:
use
1)
** Pumps / components will only be accepted if proof is provided that they have been properly cleaned.
By arrangement, cleaning can be done by
• • • • yes
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• • • • yes
• • • • yes
• • • • yes
• • • • yes
• • • • yes
• • • • yes
.
Danger class
• • • • yes
Company Stamp:
(
Date of Purchase:
Serial No.:
• • • • no
• • • • no
• • • • no
• • • • no
• • • • no
• • • • no
• • • • no
• • • • no
)