Instruction Manual

Appendix
1.02
Laborota 4000/4001 efficient, 4010/4011 digital, 4002/4003 control 139
11.6 Declaration on absence of hazards
Should your instrument require repairs, please complete this declaration and
mail or fax it to Heidolph Instruments GmbH & Co KG (see chapter
8.4,
page
125).
1. Information about the instrument
Type code
Serial number
Reason for
sending
2. Was the instrument cleaned,
decontaminated or disinfected?
yes no
3. Is the instrument in a state that
would not represent a health
hazard to service personnel?
yes no
If not, to what substances has the
instrument been exposed?
4. Information about sender
Surname, first
name
Company
Department
Street address
City, postcode/ZIP
Country
Telephone
E-mail
5. Legally binding declaration The client hereby accepts liability for
damages suffered by the client
arising from incomplete or incorrect
information.
Date
Signature