Grundfos MTA 30 Instrucciones De Instalación Y Funcionamiento página 32

Appendix
Certificate of cleanliness
Please provide all pertinent information
Product Description
Product Number
The r The ref ef ef ef efer er er er erenced pr The r enced pr enced pr oduc oduct t t t t has been e oduc
The r The r enced pr enced produc oduc
If yes es es es es, c , c , c , c , complete SECT If y If y If y If y omplete SECT omplete SECT omplete SECT omplete SECTION A. If no ION A. If no, c , c , c , c , con ION A. If no ION A. If no ION A. If no
S A: T
ECTION OXIC
(To be completed if applied substances are hazardous)
P P P P P lease specif lease specif lease specify all haz lease specif lease specif y all haz y all haz y all hazar ar ar ar ardous ma y all haz dous ma dous ma dous materials/ dous ma
P P P P P r r r r r o o o o o vide the Ma vide the Ma vide the Material Saf vide the Ma terial Saf terial Saf terial Safety Da ety Da ety Da ety Data Sheet
vide the Ma terial Saf ety Da
substances. Also, pr substances. Also substances. Also , pr , pr , pro o o o o vide an vide any ac vide an vide an
substances. Also substances. Also , pr vide an
af af af af after cleaning and/ ter cleaning and/ ter cleaning and/or flushing). ter cleaning and/ ter cleaning and/ or flushing). or flushing). or flushing). or flushing).
The pr The produc The pr The pr The pr oduc oduc oduc oduct t t t t r r r r returned has been dec eturned has been dec eturned has been dec eturned has been decon eturned has been dec
used. used. used. used. used.
S B: N -T
ECTION ON
(To be completed if applied substances ar ar ar ar are not
The pr The pr oduc oduct t t t t r r r r returned has not oduc eturned has not eturned has not
The pr The pr The produc oduc eturned has not eturned has not handled or been in c
dr dr dr dr drained of liquid and is saf ained of liquid and is safe to handle ained of liquid and is saf ained of liquid and is saf ained of liquid and is saf
I hereby declar I her I her eby declare tha eby declar eby declar e tha e tha e that t t t t the c the con the c the c onten on on
I her I her eby declar e tha the c on
classified, pack classified, packed, mark classified, pack classified, pack classified, pack ed, mark ed, mark ed, marked and labeled, and ar ed, mark ed and labeled, and are in all r ed and labeled, and ar ed and labeled, and ar ed and labeled, and ar
in in in in interna terna terna ternational and na terna tional and national go tional and na tional and na tional and na tional gov v v v v ernmen tional go tional go tional go
c c c c c onsider onsider onsidera a a a a tion during shipmen onsider tion during shipment t t t t . (A r tion during shipmen tion during shipmen
onsider tion during shipmen
and authoriz and authoriz and authorized by a qualified member of staf and authoriz and authoriz ed by a qualified member of staff emplo ed by a qualified member of staf ed by a qualified member of staf ed by a qualified member of staf
C C C C C O O O O O MP MP MP MPAN AN AN ANY Y Y Y Y NA NA NAME NA ME ME ME
MP AN NA ME
NA NA NA NA NAME ME ME ME ME
SIGNA SIGNAT T T T T U U U U U R R R R R E E E E E SIGNA SIGNA SIGNA
R R R R R adioac adioac adioac adioactiv adioac tive pr tiv tiv tiv e produc e pr e pr e pr oducts will not oduc oduc oduc ts will not be accepted f ts will not ts will not ts will not be accepted f be accepted f be accepted for r be accepted f
this form must accompany the returned product. It is the senders responsibility to package, transport and complete the shipping documents regarding the
nature of the product shipped. Irrespective of this, Grundfos reserves the right to reject the service order for other reasons. Grundfos will rely on this
representation and will look to the customer for reimbursement of any and all costs, claims or damages incurred, including attorney's fees, if any representation
is not correct.
Grundfos Pumps Corporation
17100 W. 118th Terrace
Olathe, Kansas 66062
Telephone: 913.227.3400
Fax: 913.227.3500
L-QC-FRM-002 Rev. 08/03
PRINTED IN USA
www.grundfos.com
32
APPLICATION
has been e has been e xposed to to xposed to to xic or haz xic or haz xic or hazar ar ar ar ardous ma
has been exposed to to has been e xposed to to xposed to toxic or haz xic or haz
on on ontinue to SECT on tinue to SECT tinue to SECT tinue to SECT tinue to SECTION B
C
LEARANCE
terials/ terials/ terials/ terials/substances used with the r substances used with the r substances used with the r substances used with the r substances used with the ref ef ef ef efer er er er erenced pr
ta Sheet ta Sheet f f f f for all ma ta Sheet or all ma or all ma or all materials r terials ref ef ef ef efer er er er erenced or list terials r terials r
ta Sheet or all ma terials r
y actions to be tak y ac y ac tions to be taken in the e tions to be tak tions to be tak en in the e en in the e en in the ev v v v v en
y ac tions to be tak en in the e
on on on ontamina tamina tamina taminated, dr tamina ted, dr ted, dr ted, dr ted, drained of liquid and is saf ained of liquid and is safe to handle ained of liquid and is saf ained of liquid and is saf ained of liquid and is saf
C
OXIC LEARANCE
e not e not e not hazardous) e not
handled or been in c handled or been in c on on tact t t t t with an tac tac
handled or been in con handled or been in c on ontac tac
e to handle e to handle e to handle e to handle. . . . .
tents of this c ten ten ts of this c ts of this c ts of this consignmen onsignment t t t t ar ar ar ar are fully and accur onsignmen onsignmen e fully and accur e fully and accur e fully and accura a a a a tely described abo
ten ts of this c onsignmen e fully and accur
e in all r e in all r e in all r e in all respec espec espec espec espects in pr ts in proper c ts in pr ts in pr ts in pr
ernmental r ernmen ernmen ernmen tal regula tal r tal r tal r egulations. Health and saf egula egula egula tions. Health and saf tions. Health and saf tions. Health and saf tions. Health and safety issues ar
. (A r . (A r epair or inspec epair or inspec tion of pr tion of pr oduct t t t t will only be under oduc oduc
. (A r . (A repair or inspec epair or inspection of pr epair or inspec tion of pr tion of produc oduc
f employ y y y y ed by the r f emplo f emplo f emplo ed by the r ed by the r ed by the returning c ed by the r
or repair or r or r or r epair epair epair. . . . . A return material authorization number from Grundfos, along with a completed and signed copy of epair
Health and Safety Clearance Form
Quantity
dous ma dous ma terials: terials:
dous materials: dous ma terials: terials:
ION B. . . . . ION B ION B ION B
enced produc enced pr enced pr enced pr oduc oduct(s oduc oduc t(s t(s). ). ). ). ). t(s t(s
enced or list pr pr pr pr precautions to be tak enced or list enced or list ecautions to be taken when handling these ecautions to be tak ecautions to be tak
enced or list ecautions to be tak
en en en ent t t t t of human c of human c of human c of human con on on ontac tact t t t t with an tac tac with an with an with any liquid within the pr
of human c on tac with an
e to handle e to handle e to handle. P e to handle . Pr r r r r o o o o o vide dec . P . P . P
with an with an y to y to xic or hazar ar ar ar ardous substances. xic or haz xic or haz dous substances. dous substances.
with an with any to y toxic or haz y to xic or haz dous substances. The pr dous substances.
tely described abo tely described abov v v v v e by pr tely described abo
tely described abo
oper c oper c oper c oper condition f ondition f ondition f ondition for tr ondition f or transpor or tr or tr or tr anspor anspor anspor ansport, by all modes t, by all modes t, by all modes, acc t, by all modes t, by all modes
ety issues ar ety issues are clearly understood and will be giv ety issues ar ety issues ar e clearly understood and will be given e clearly understood and will be giv e clearly understood and will be giv e clearly understood and will be giv
will only be under will only be under tak tak en when this cer en when this cer
will only be under will only be undertak tak taken when this cer en when this certifica en when this cer
eturning c eturning compan eturning c eturning c ompan ompan ompan ompany y y y y .) .) .) .) .)
P P P P P O O O O O SIT SITION SIT SIT SIT ION ION ION ION
PHONE E E E E PHON PHON PHON PHON
GRUNDFOS
Certificate of Cleanliness
Y Y Y Y Y ES ES ES NO NO
ES ES NO NO NO
en when handling these en when handling these en when handling these
en when handling these
y liquid within the pr y liquid within the pr y liquid within the produc oduc oduct t t t t (e (e (e (e (ev v v v v en oduc en en en en
y liquid within the pr oduc
vide dec vide dec vide dec vide decon ontamina on on on tamina tamina tamina tamination method tion method tion method tion method tion method
Initial/Da Initial/Date te te te te Initial/Da Initial/Da Initial/Da
The pr The pr oduct t t t t has been oduc oduc has been has been
The pr The produc oduc has been has been
Initial/Da Initial/Da Initial/Da Initial/Da Initial/Date te te te te
e by pr e by pr e by proper shipping name and ar oper shipping name and ar oper shipping name and are e e e e oper shipping name and ar
e by pr oper shipping name and ar
, acc , acc , accor or or or ording to applicable , acc ding to applicable ding to applicable ding to applicable ding to applicable
tifica tifica te has been c te has been c ompleted ompleted
tificate has been c tifica te has been completed te has been c ompleted ompleted
1
en en en en