Grundfos DMX 221 Notice D'installation Et De Fonctionnement page 55

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Appendix B
B.1. Safety declaration
Please copy, fill in and sign this sheet and attach it to the product returned for service.
Fill in this document using English or German language.
Fault description
Please make a circle around the damaged part.
In the case of an electrical or functional fault, please mark the cabinet.
Please give a short description of the fault and indicate if the diaphragm is damaged:
Declaration
We hereby declare that this product is free from hazardous chemicals, biological and radioactive substances:
Type designation (see nameplate):
Product number:
The product was used with the following dosing medium:
No dosing medium or water:
A chemical solution, name:
Date and signature:
Company stamp:
813

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