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Idiomas disponibles
Idiomas disponibles
A vacuum pump and its accessories may in some cases draw up or be in contact with hazardous substances. For
reasons of safety of the staff or our after sales and repair departments, and in accordance with the regulations, it
is mandatory that you complete this form with the following essential information when returning the
equipment to the factory for repair. Otherwise, the products received will be isolated in a quarantine area and
no human intervention may be undertaken.
Machine type:
Serial no.:
Date of sending:
:
Cause for return
What type of oil is used for the pump:
Presence of bacteriological filtration:
Presence of bacteriological cartridge:
Does the device contain toxic substances:
Does the device contain corrosive substances:
Does the device contain CMR* substances:
Does the device contain explosive substances:
Does the device contain radioactive substances :
Others: ............................................................................................
(*) CMR : carcinogenic - mutagenic - reprotoxic
If radioactive or explosive materials are present, list the substances of the gas and the by-products:
Product name
Legal declaration
We declare on our honour that the data in this declaration was provided exhaustively, sincerely and factually
and that the undersigned is qualified to judge this. We are aware that we are liable in relation to the
contractor for incomplete or incorrect data. We commit ourselves to exempt the contractor from any
responsibility in relation to third parties in respect of damage and interests owed to incomplete or incorrect
data. We are aware that beyond this declaration, our responsibility is directly engaged in relation to third
parties, which includes in particular the employees of the contractor responsible for handling/repairing the
product.
Company:
...................................................................
Street:
.........................................................................
Name (in capital letters):
Telephone:
.................................................................
Date:
25
SAFETY SHEET
...................................................
....................................................
...................................................
...................................................
ESSENTIAL INFORMATION
YES
Chemical
composition
............................................
YES
YES
YES
YES
YES
YES
NO
YES
Risk category
Postal code/City:
...............................................................
Fax: ....................................................................................
Position:
...........................................................................
Company seal:
.................................................................
Signature:
NO
NO
NO
NO
NO
NO
NO
First aid
517619-05
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