Decontamination Declaration - VWR VP 8 Vac Manuel D'instructions

Decontamination Declaration

The condition for the repair of a pump by VWR is the certification of the customer on the transferred
media and on the cleaning of the pump (decontamination declaration).
 Copy this page.
 Enter the pump model, the Serial No. and the transferred media in the form below and sent the signed
form together with the flushed and cleaned pump to VWR Customer Service.
Europe
VWR International bvba
Researchpark Haasrode 2020
Geldenaaksebaan 464
B-3001 Leuven
+ 32 16 385011
http://be.vwr.com
Customer decontamination declaration for repair order
We herewith confirm that the following media have been pumped with the pump listed below, and that the
pump has been flushed and cleaned.
Pump model
Serial No.
Fed media
The pump contains neither aggressive, biological, radioactive, poisonous nor other dangerous media.
Company
80
Date/Signature