Déclaration De Contamination - Knick Ceramat WA 150 Mode D'emploi

Déclaration de contamination
Ceramat® WA 150
Declaration on the potential hazards presented by
the enclosed devices/sensors
For acceptance and execution of your order we require this completed declaration form.
Please enclose it with the shipping documents.
Customer data
Company name:
Address:
Contact person:
Device/sensor specifications
Sensor:
(Catalog number)
Serial no.
Your order number:
Knick order confirmation no.:
Included accessories:
Reason for return of product:
Warning notices as to the medium in which the device/sensor has been used
(please tick where applicable):
harmless harmful/
irritant
Cleaning measures taken before shipment (cleaning methods and cleaning agents used):
1.
3.
I herewith declare that the shipped parts do not pose any health hazards for employees of Knick
Elektronische Messgeräte GmbH & Co. KG. I further declare that I have answered the questions above
truthfully and to the best of my knowledge. I understand that I may be held liable for any damage
resulting from false or incorrect information.
Name:
Date:
Knick Elektronische Messgeräte GmbH & Co. KG, Beuckestraße 22, 14163 Berlin
Telefon: ++49 (0) 30 8 01 91 – 0 / Telefax: ++49 (0) 30 8 01 91 – 200
toxic / corrosive
2.
4.
Company:
Signature:
Email: knick@knick.de / Internet: www.knick.de
Phone:
oxidizing /
explosive
infectious /
radioactive
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