Endress+Hauser CPM280 Betriebsanleitung Seite 61

Declaration of Hazardous Material and De-Contamination
RA No.
Because of legal regulations and for the safety of our employees and operating equipment, we need the "Declaration of Hazardous Material
and De-Contamination", with your signature, before your order can be handled. Please make absolutely sure to attach it to the outside of the
packaging.
Type of instrument / sensor
Used as SIL device in a Safety Instrumented System
Process data
Medium and warnings
Medium /concentration
Process
medium
Medium for
process cleaning
Returned part
cleaned with
Please tick should one of the above be applicable, include safety data sheet and, if necessary, special handling instructions.
Description of failure
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Company data
___
Company ________________________________
_________________________________________________
Address
_________________________________________________
_________________________________________________
"We hereby certify that this declaration is filled out truthfully and completely to the best of our knowledge.We further certify that the returned
parts have been carefully cleaned. To the best of our knowledge they are free of any residues in dangerous quantities."
(
place, date)
Please reference the Return Authorization Number (RA#), obtained from Endress+Hauser, on all paperwork and
mark the RA# clearly on the outside of the box. If this procedure is not followed, it may result in the refusal of the
package at our facility.
____________________________________________
Temperature _____ [°F]
Conductivity ________
Identification
CAS No.
* explosive; oxidising; dangerous for the environment; biological risk; radioactive
________________________________________________________________________
Name, dept.
(please print)
_____
[°C]
[µS/cm]
toxic corrosive
flammable
Phone number of contact person
____________________________________________
Fax / E-Mail ____________________________________________
Your order No. ____________________________
Serial number ________________________
_____
Pressure _____ [psi]
_____
Viscosity _____ [cp]
harmful/
other *
irritant
Signature
[ Pa ]
2
[mm /s]
harmless