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BÜCHILabortechnikAG Appendix|10

OperationManualInterfaceI100 39/42

10.5 Healthandsafety

Declarationregardingthesafety,hazardsandsafedisposalofwaste

Toguaranteethehealthandsafetyofourstaffandtocomplywiththelawandthereg

ulationsforhandlinghazardousmaterials,regardinghealthandsafetyatwork,andto

complywithsafetyregulations,healthandsafetyrequirementsandrequirementsfor

safedisposalofwastesuchaschemicalwaste,chemicalresiduesorsolvents,the

formbelowmustbefullycompletedandsignedwheneverdevicesorfaultycompo

nentsaretobesentbacktoourfactory.

Productsorcomponentswillnotbeacceptedifthisdeclarationhasnotbeen

provided.

Device

Model: Part/Deviceno.:

Declarationfor

nonhazardous

materials

Weherebyassurethattheproductsreturned

havenotbeenusedinthelaboratoryandarenew.

havenotbeenincontactwithtoxic,corrosive,biologicallyactive,explosive,ra

dioactiveorotherhazardousmaterials.

arenotcontaminated.Thesolventsorresiduesofthesubstancespumpedhave

beenremoved.

Declarationfor

hazardousmateri

als

Inrespectoftheproductsreturned,weherebyassurethat

allsubstances(toxic,corrosive,biologicallyactive,explosive,radioactiveorother

wisehazardous)thathavebeenpumpedbytheproductsorhaveotherwisebeen

incontactwiththeproductsarelistedbelow.

theproductshavebeencleaned,decontaminated,sterilisedinsideandoutside

andallinletsandoutletsaresealed.

Listofhazardousmaterialsthathavebeenincontactwiththeproducts:

Chemical,material Hazardcategory

Finaldeclaration Weherebydeclarethat

 wearefullyconversantwiththesubstancesthathavebeenincontactwiththeprod

uctsandhaveansweredallquestionscorrectly.

 wehavetakenallmeasuresnecessarytopreventpotentialhazardsinrespectof

theproductsreturned.

Companynameorstamp:

Place,date:

Name(blockletters),position

(blockletters):

Signature:

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