
9
Equipment Decontamination Certificate
To enable us to comply with german law (i.e. §71 StrlSchV, §17 GefStoffV and §19 ChemG) and to
avoid exposure to hazardous materials during handling or repair, will you please complete this form,
prior to the equipment leaving your laboratory
COMPANY / INSTITUTE ___________________________________________________________________
ADDRESS _______________________________________________________________________________
TEL NO _______________________________ FAX NO_______________________________
E-MAIL __________________________________________________________________________________
EQUIPMENT Model Serial No
__________ __________
__________ __________
__________ __________
__________ __________
If on loan / evaluation Start Date: ________ Finish Date ________
Hazardous materials used with this equipment
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Method of cleaning / decontamination
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
The equipment has been cleaned and decontaminated:
NAME ________________________________ POSITION ___________________________
(HEAD OF DIV./ DEP./ INSTITUTE / COMPANY)
SIGNED ______________________________ DATE _______________________________
PLEASE RETURN THIS FORM TO BIOMETRA GMBH OR YOUR LOCAL BIOMETRA
DISTRIBUTOR TOGETHER WITH THE EQUIPMENT.
PLEASE ATTACH THIS CERTIFICATE OUTSIDE THE PACKAGING. INSTRUMENTS WITHOUT
THIS CERTIFICATE ATTACHED WILL BE RETURNED TO SENDER.