Declaration of Decontamination Error description

Email [email protected] Link to the online form Applies to all returned equipment (if this is not the case, please duplicate this form and fi...

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Declaration of Decontamination Error description Status: July 2019

Before your order can be processed it is imperative that you fill out this Declaration of Decontamination in its entirety and sign it. Doing so is mandatory in accordance with legal regulations and serves to protect our employees and equipment. Delivery address

If you have any questions about product returns Tel. +49 208 4952-370 Email [email protected] Link to the online form

Attach this document to the outside of the packaging in such a way that it is clearly legible and will remain dry!

Originator Company

Department

Contact

Phone

Street/No.

Fax

City, zip code

Email

Country

Customer order/reference no.

Turck order no. (ZTU)

Turck RMA no.

End customer Desired report format

Support case no. (CRM) 8D

Rental device from

Final report

Device type

Quantity

Ident no.

Batch no.

Location/environment for use Reason for the return (complaint, repair, service, incorrect quantity, rental device, etc.)

Warnings Regarding Ambient Conditions of the Product

 Radioactive

Flammable

Toxic

Corrosive

Concentration During the process

Health hazard

Other*

Safe

Cleaning with Final cleaning with * Other: Please specify, e.g. explosive, oxidizing, harmful to the environment, biological hazard

The following safety precautions regarding residual liquids, rinsing agents and disposal must be followed (send safety data sheet in advance)

Fault Description/Further Information

Applies to all returned equipment (if this is not the case, please duplicate this form and fill it out for the individual devices) I agree to the Privacy Policy (link to Privacy Policy)

Place/date

Signature

Hans Turck GmbH & Co. KG | 45466 Mülheim an der Ruhr, Germany | T +49 208 4952-0 | F +49 208 4952-264 | [email protected] | www.turck.com

FM 7.5-5

I confirm that I have filled out this declaration in its entirety and truthfully, to the best of my knowledge. The returned parts have been thoroughly cleaned and are free from residues of hazardous substances. The parts therefore present no risk to third parties.