Description Of The Equipment - Leybold vacuum Sogevac SV25 B Mode D'emploi

Declaration of Contamination of Compressors, Vacuum Pumps and Components
The repair and / or servicing of compressors, vacuum pumps and components will be carried out only if a correctly
completed declaration has been submitted. Non-completion will result in delay. The manufacturer can refuse
to accept any equipment without a declaration.
A separate declaration has to be copleted for every single component.
Customer/Dep./Institute:
Address:
Person to contact:
Phone:
Order number of customer:
A. Description of the equipment
Type:
Catalogue number:
Serial number:
Type of oil used:
B. Condition of the equipment
1. Has the equipment been used?
2. Drained (Product/service fluid)
3. All openings sealed airtight
4. Purged
If yes which cleaning agent
and which method of cleaning?
C. Description of processed substances
1. What substances have come into contact with the equipment:
Trade name and / or chemical term of service fluids and substances processed, properties of the substances
According to safety data sheet (e.g. toxic, inflammable, corrosive, radioactive)
X Tradename
a)
b)
c)
d)
2. Are these substances harmful?
3. Dangerous decomposition products when thermally loaded:
Which:
Components contaminated by microbiological, explosive or radioactive products will not be accepted without written evi-
dence of decontamination.
D. Legally binding declaration
I / we hereby declare that the information supplied on this form is accurate and sufficient to judge any contamination level.
Name of authorised person (block letters):
Date:
Fax:
(machine or component)
No
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Chemical name:
Signatur of authorised person:
Reason for returning
I I
repair
I I
exchange
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DKD-calibration
Restoring goods because of following reason:
I I
rent/loan
I I
exchange already received/arranged
Ancillary equipment:
Yes No
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(Please fill in absolutely)
Yes No
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I I
X applicable please mark
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chargeable
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chargeable
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factory calibration
I I I I
for credit
Contamination:
toxic
corrosive
microbiological
explosive
radioactive
other harmful substances
Firm stamp:
GA02314_01 - 01/2005
warranty
warranty
against exchange
No Yes
I I I I
I I I I
I I I I
I I I I
I I I I
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