Grundfos AC 15 Instructions D'installation Et D'utilisation page 17

Please copy, fill in and sign this sheet and attach it to the pump returned for service.
Which media has the pump been used for: ______________________
In which application has the pump been used: ____________________
(In case of an electrical fault, please mark the terminal box.)
Please give a short description of the fault:
We hereby declare that this product is free from hazardous chemicals,
biological and radioactive substances.
_________________________
Date and signature
224
Safety declaration
Media and application
Fault description
If possible please make a circle around the faulty part.
_________________________
Company stamp