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Clearance Certificate
Product
Type
the product was carefully emptied before shipping / delivery, and cleaned inside and outside.
Conveying medium
Designation
Properties
Please tick!
If either of the listed properties,
then enclose the appropriate
safety and handling instruc-
□
tions.
The product was used with health or water-polluting substances and came up with labeling
requirements and pollution prone media in contact.
Special security arrangements with respect to health or water-hazardous media
are in the further handling
The following safety precautions regarding rinsing, residual liquids and waste disposal are required:
Process data
The product was used with the following operating conditions described conveying medium:
Temperature
Sender
Company:
Contact person:
Address:
Zip code, City:
We confirm that we have the information in this safety certificate
completely and that the returned parts were carefully cleaned.
The parts are sent free of residues of dangerous amount.
Place, Date
www.sera-web.com
□
Toxic
□
Harmless
□
Explosive
°C
Telephone:
FAX:
E-mail:
Your order No:
Department
Serial-No.
Concentration
□
□
Corrosive
Flammable
□
□
Dangerous for
Irritant
the environment
Pressure
(Clearance
Certificate) have been correctly and
Signature
(and company stamp)
□
YES
%
□
□
Oxidising
Unhealthy
□
□
Bio-
Radioactive
hazardous
□
YES
□
NO
□
not required
□
required
bar
www.sera-web.com
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