Déclaration De Non-Opposition - Lutz-Jesco MEMDOS SMART LB Instructions De Service

Pompe doseuse à membrane entraînée par moteur pas à pas MEMDOS SMART LB / LD
17 Déclaration de non-opposition
Copiez cette déclaration, apposez-la à l'extérieur de l'emballage et
envoyez-la avec l'appareil !
Declaration of no objection
Please fill out a separate form for each appliance!
We forward the following device for repairs:
Device and device type: ................................................................
Order No.:.....................................................................................
Reason for repair: ......................................................................................................................................................................................
..................................................................................................................................................................................................................
..................................................................................................................................................................................................................
Dosing medium
Description: ..................................................................................
Properties: ....................................................................................
We hereby certify, that the product has been cleaned thoroughly inside and outside before returning, that it is free from hazardous
material (i.e. chemical, biological, toxic, flammable, and radioactive material) and that the lubricant has been drained.
If the manufacturer finds it necessary to carry out further cleaning work, we accept the charge will be made to us.
We assure that the aforementioned information is correct and complete and that the unit is dispatched according to the legal
requirements.
Company / address:......................................................................
.....................................................................................................
.....................................................................................................
Customer No.:...............................................................................
Date, Signature:............................................................................
Déclaration de non-opposition
42
Part-no.:...................................................................................
Date of delivery: .......................................................................
Irritating:
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Corrosive:

Phone:......................................................................................
Fax:..........................................................................................
Email:.......................................................................................
Contact person: ........................................................................
BA-10110-03-V01
Instructions de service
Yes No
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Yes No
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© Lutz-Jesco GmbH 2016