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Declaration
The repair and/or service of vacuum equipment/compo-
nents can only be carried out if a cqrrectly completed
ration
has been submitted.
This declaration
may only be completed
1. Description
of component
Equipment
type/model•
— Code
No-:
— Serial
No.:
— Invoice
No.-
— Delivery Date:
3. Equipment
condition
—Has the equipment
Yes
What type of operating medium was used ?
— Is the equipment
free from potentially
harmful
substances?
Yes
No
e) We will not accept any equipment/components which have been radioactively, explosively or microbiologically conta-
minated without written evidence that such equipment/components
Please list all harmful substances, gases and dangerous by-products
ment/components:
Trade
name
Product
name
Manufacturer
2.
3.
4.
5.
5. Legally Binding Declaration
I hereby declare that the information
accordance with the appropriate
Name of Organisation:
Address:
Tel:
Fax:
Name:
Job
title:
Date:
Legally binding signature:
of Contamination
Non-completion
will result
and signed by authorised
been used ?
No
C
(go to Section 5)
(go to Section 4)
Chemical
name
and symbol
supplied on this form is complete and accurate. The despatch of equipment
regulations covering Packaging, Transportation
of Vacuum
Equipment
delay. The manufacturer
decla-
tance of consignments
work
where
the
in
and qualified
2-
Reason
for
4.
Process
related
of equipment/components
— toxic
— corrosive
—explosive•)
—microbiological*)
— radioactive')
— other
harmful
have been decontaminated
which have come into contact with the vacuum equip-
Danger class
Precautions
with
substance
Post
code:
Telex:
Company stamp:
BALZERS
and Components
reserves
the right
submitted
for repair or maintenance
declaration
has
been
omitted.
staff.
return:
contamination
Yes
Yes
Yes
Yes
Yes
substances
Yes
in the prescribed manner.
associated
First aid measures
the
event
and Labelling of Dangerous Substances.
BALZERS
to refuse
accep-
No
No
No
Ü
No
No
No
in
of an accident
will be in
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