HEALTH AND SAFETY DECLARATIO N
FOR USED VA CUUM EQUIPMENT A ND COMPONENTS
The repair and/or service of vacuum equipment/components can only be carried out if a correctly completed declar-
ation has been submitted for every component.
1. Description of components
Model
Serial number
2. Reasons for return
3. Equipment condition
Has the equipment ever come into contact with the following (e.g. gases, liquids, evaporation products, sput-
tering products…)
Yes
No
toxic substances?
¨
¨
corrosive substances?
¨
¨
microbiological substances (incl. sample material)?
¨
¨
radioactive substances (incl. sample material)?
¨
¨
ionizing particles/radiation (α, β, γ, neutrons, ...)?
¨
¨
Is the equipment free from potentially harmful and hazardous substances?
¨
¨
4. Decontamination Procedure
List all harmful substances, gases and by-products which have come into contact with the vacuum equip-
ment/component and the decontamination method used. Continue on a separate sheet if necessary.
Substance
Decontamination Method
5. Legally Binding Declaration
Organization
Address
Phone/Fax
Name/Position
I hereby declare that the information supplied on this form is complete and accurate.
Date
Signature
Company Stamp
SPECS
Health and Safety Declaration | Page 1/1
Summary of Contents for XR 50
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