Grundfos AC Serie Montage- Und Betriebsanleitung Seite 16

Please copy, fill in and sign this sheet and attach it to the pump returned for service.
Which media has the pump been used for: ______________________
In which application has the pump been used: ____________________
(In case of an electrical fault, please mark the terminal box.)
Please give a short description of the fault:
We hereby declare that this product is free from hazardous chemicals,
biological and radioactive substances.
_________________________
Date and signature
224
Safety declaration
Media and application
Fault description
If possible please make a circle around the faulty part.
_________________________
Company stamp