Type
Order number/ Order item number *)
Delivery date
Field of application
Fluid handled *)
Please tick where applicable *)
Reason for return *)
Comments
The pump/accessories have been carefully drained, cleaned and decontaminated inside and outside
prior to dispatch/placing at your disposal.
On sealless pumps the rotor has been removed from the pump for clearing.
No special safety precautions are required for further handling.
The following safety precautions are required for flushing fluids, fluid residues and disposal
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We confirm that the above data and information are correct and complete and that dispatch is affected
in accordance with the relevant legal provisions.
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Place, date and signature
*) Required fields
Decontamination certificate
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Address
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Company stamp
AU