SERVICE
5
29
OPTIWAVE X400
www.krohne.com
06/2021 - 4006413503 - AD NEPSI OPTIWAVE x400 R03 en
5.8.2 Form (for copying) to accompany a returned device
CAUTION!
To avoid any risk for our service personnel, this form has to be accessible from outside of the
packaging with the returned device.
Company:
Address:
Department:
Name:
Telephone number:
Fax number:
Email address:
Manufacturer order number or serial number:
The device has been operated with the following medium:
This medium is:
radioactive
water-hazardous
toxic
caustic
flammable
We checked that all cavities in the device are free from such substances.
We have flushed out and neutralized all cavities in the device.
We hereby confirm that there is no risk to persons or the environment caused by any residual media contained in this
device when it is returned.
Date:
Signature:
Stamp:
