Buchi SpeedDigester K-425 Manuel D'utilisation page 51

Health and Safety Clearance
Declaration concerning safety, potential hazards and safe disposal of waste.
For the safety and health of our staff, laws and regulations regarding the handling of
dangerous goods, occupational health and safety regulations, safety at work laws and
regulations regarding safe disposal of waste (e.g. chemical waste, chemical residues
or solvents) require that this form must be completed, signed and enclosed to every
return shipment of equipment or defective parts.
Instruments or parts will not be accepted if this declaration is not present.
Equipment
Model:
1.A Declaration for non dangerous goods
We assure that the returned equipment:
is unused and new.
has not been exposed to toxic, corrosive, biologically active, explosive, radioactive
or other dangerous matters. No hazard emanates from the device!
is free of contamination (e.g.that chemicals, solvents or residues of pumped media
have been drained prior to shipment). No hazard emanates from the device!
1.B Declaration for dangerous goods
Exhaustive list of dangerous substances the equipment has been exposed to:
Chemical, substance
We assure that:
all hazardous substances (e.g. toxic, corrosive, biologically active, explosive,
radioactive etc.) which have been processed or been in contact with the equipment
are listed above.
the equipment has been cleaned, decontaminated and is free of transmissible
agents such as hazardous fungi, bacteria, viruses etc. If sterilization is applicable,
all in- and outlets of the equipment have been properly sealed the process.
2. Final Declaration
We hereby declare that:
- we know all about the substances which have been in contact with the equipment
and all questions have been answered correctly.
- we have taken all measures to prevent potential risks that might emanate from the
delivered equipment.
- this document will be attached clearly visible and securely to the outside of the
transport box.
Company name or stamp:
Place, date:
Name (print), job title (print):
Signature:
Health and Safety Clearance_20081110_KESS.doc_20081110
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9 Mise hors service, rangement, transport et mise au rebut
Part/Instrument no.:
Danger classification
Version 1.0 Page 1/1
K-425 / K-436 Manuel d'instructions, version B