Richter MNKA Series (ASME) User Manual download pdf (Page 29)

Declaration about the Contamination of

Richter Pumps, -Valves

and Components

Prepared: CRQ/Lam on: Feb. 15, 06 Page: 2 QM No.: 0912-16-2001_en/4-06

Approved: CRQ/Zu on: Feb. 15, 06 of : 2

he repair and/or maintenance of pumps, valves and components can only be implemented if a completely filled out

declaration is available. If this is not the case, delay of the work will occur.

If this declaration is not attached to the

devices, which have to be repaired, the transmission can be rejected.

Every aggregate has to have it’s own declaration.

This declaration may be filled out and signed only by authorized technical personnel of the operator.

Contractor/dep./institute : Reason for transmitting  Please mark the applicable

Repair:  subject to fee  Warranty

Street :

Exchange:  subject to fee  Warranty

Postcode, city:  Exchange/ Replacement already initiated/received

Contact person:

Return:  Leasing  Loan  for credit note

Phone : Fax :

End user :

A. Details of Richter-product:

Failure description:

Classification:

Article number:

Equipment:

Serial number:

Application tool:

Application process:

B. Condition of the Richter-product:

yes no

Contamination : no

yes

Was it in operation ?

  toxic  

Drained (product/operating supply item) ?

  caustic  

All openings hermetically locked!

 inflammable  

Cleaned ?

 

explosive

 

If yes, with which cleaning agent:

mikrobiological

 

and with which cleaning method:

radioactive

if "no", then forward to D.

other pollutant  

Aggregates, which are contaminated with microbiological or explosive substances, are only

accepted with documented evidence of an approved cleaning.

Aggregates, which are contaminated with radioactive substances, are not accepted in principle.

C. Details of the discharged materials (must be filled out imperatively)

With which materials did the aggregate come into contact ? Trade name and/or chemical

designation of operational funds and discharged materials, material properties, e.g. as per

safety data sheet (e.g. toxic, inflammable, caustic)

X Trade name: Chemical designation:

no yes

2. Are the materials specified above harmful to health ?

 

3. Dangerous decomposition products during thermal load ?

 

If yes, which ones ?

D. Mandatory declaration: We assure that the data in this explanation are truthful and complete and as a signatory I am

able to form an opinion about this. We are aware that we are responsible towards the contractor for damages, which results

from incomplete and incorrect data. We commit ourselves to exempt the contractor from claims for damages of thirds

resulting from incomplete or incorrect data. We are aware that we are directly responsible towards thirds, irrespective of this

declaration, which belongs in particularly to the employees of the contractor consigned with the handling repair of the product.

Name of the authorized person

(in block letters):

Date Signature

Company stamp

1 2 ... 24 25 26 27 28 29 30

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Richter MNKA Series (ASME) User Manual Page 29

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