Grundfos DMX 221 Notice D'installation Et De Fonctionnement page 27

Annexe
Please copy, fill in and sign this sheet and attach it to the pump returned for service.
We hereby declare that this product is free from hazardous chemicals,
No media or water: _____________________________
A chemical solution, name: _________________________
In the case of an electrical or functional fault, please mark the cabinet.
Please give a short description of the fault:
_____________________
Date and signature
Safety declaration
Fill in this document using English or German lan-
Nota
guage.
biological and radioactive substances:
Product type: ________________________________
Model number: _____________________________
(see pump nameplate)
Fault description
Please make a circle around the damaged part.
_____________________
Company stamp
1
27