FPZ SCL R20-MD MOR IE2 Instructions page 119

Fill out and return to:
(please wait for a confirmation by FPZ Service)
MACHINE / PRODUCT DATA
Type of machine / Model
Cause
Description of defect
DECLARATION OF DECONTAMINATION
•
For the safety of our employees and compliance with the legal requirements during handling of substances hazardous to health
and the environment, this declaration must be filled out completely and sent for each machine / product.
•
Without said declaration filled out completely, repair cannot be carried out.
•
The declaration must be sent with the shipping documents.
1. The machine / the product
has NOT come into contact with hazardous substances. In case of repair / disposal, there is no risk to people and the
environment. Go to point 3.
has come into contact with hazardous substances. Go to point 2.
2. Information on contamination
Type of system on which the machine is installed:
And it has come into contact with the following substances subject to the requirement of labelling or dangerous to health /
environment:
Trademark
The machine / product has been washed and cleaned on the outside. Specify the decontamination method used:
3. Legally binding declaration
The undersigned hereby declares that the details given on this form are true and complete.
APPLICANT'S DETAILS
Company name:
Street:
City:
Contact person:
E-mail / tel. no.
DESTINATION
ADDRESS
COMPLETION BY FPZ CUSTOMER CARE
RMA no.
NOTES
FPZ-MI-R-MD-MOR-GOR-IE2-15-R03
Serial no.
Repair Warranty
Blocked
Other:
Chemical name
FPZ S.p.A. - Via F.lli Cervi 16 - 20863 Concorezzo (MB) Italy
119 / 119
E-mail customercare@fpz.com
purchase doc. no.
Repair
Noisy
Hazardous substance class
Periodical maintenance
Motor failure
Characteristics (e.g.
flammable, corrosive)
Date
Postal
Code
Province
toxic,