Grundfos MTA series Montage- Und Betriebsanleitung Seite 69

Appendix
Please copy, fill in and sign this sheet and attach it to the pump returned for service.
Which medium has the pump been used for: _________________________________________
In which application has the pump been used: ______________________________________
We hereby declare that this product is free from hazardous chemicals,
biological and radioactive substances.
_________________________
Date and signature
Safety declaration
Medium and application
Fault description
If possible please make a circle around the faulty part.
(In case of an electrical fault, please mark the terminal box.)
Please give a short description of the fault:
_________________________
Company stamp
1
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