Sartorius Stedim Biotech BIOSTAT RM 20 basic Bedienungsanleitung Seite 58

Declaration about decontamination
Declaration about decontamination and cleaning of equipment and components Declaration about decontamination and cleaning of equipment and components
Declaration about decontamination and cleaning of equipment and components Declaration about decontamination and cleaning of equipment and components
To protect our personnel, we require all equipment or components be free of biological, chemical, or radioisotopic
contaminants. We will only accept such equipment or components when:
•
the equipment or components have been adequately CLEANED and DECONTAMINATED.
•
this declaring document has been completed, signed and returned by an authorized person.
Please help us in assuring a safe, hazard-free work environment.
Description of the Equipment or Component(s) Description of the Description of the Description of the Equipment or Component(s) Equipment or Component(s) Equipment or Component(s)
Description / Cat. No.:
Serial no.:
No. of invoice/delivery note:
Date of delivery:
Contamination / Cleaning Contamination / Cleaning
Contamination / Cleaning Contamination / Cleaning
Attention: Please specify exactly the biological, Attention: Please specify exactly the biological,
Attention: Please specify exactly the biological, Attention: Please specify exactly the biological,
chemical, or radioisotopic contaminant. chemical, or radioisotopic contaminant. chemical, or radioisotopic contaminant. chemical, or radioisotopic contaminant.
The equipment was contaminated with:
Legally binding declaration Legally binding declaration Legally binding declaration Legally binding declaration
I (we) certify that all information given in this form is correct and complete.
The equipment and components have been adequately decontaminated and cleaned according to the legal
requirements. No chemical or biological or radioisotopic risks remain that can endanger exposed persons' safety or
health.
Company / Institute: Company / Institute:
Company / Institute: Company / Institute:
Address / Country: Address / Country:
Address / Country: Address / Country:
Tel.: Tel.: Tel.: Tel.:
Name of the authorized person: Name of the authorized person:
Name of the authorized person: Name of the authorized person:
Position: Position:
Position: Position:
Signature / Date: Signature / Date: Signature / Date: Signature / Date:
Please pack the equipment properly and send it to your
local service representative or to Sartorius Stedim Systems
GmbH, Germany (carriage paid to receiver).
Declaration about decontamination_02.doc
Attention: Ple Attention: Please describe the cleaning and ase describe the cleaning and
Attention: Ple Attention: Ple ase describe the cleaning and ase describe the cleaning and
decontamination procedure/method. decontamination procedure/method. decontamination procedure/method. decontamination procedure/method.
and it has been cleaned and decontaminated by:
Fax (with area code): : : : Fax Fax Fax
Sartorius Stedim Systems GmbH
Technical Service
Schwarzenberger Weg 73-79
34212 Melsungen
Germany
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