Watson & Sons 520DUN Decontamination certificate, RGA number Signature Your position Date, 105

39 Decontamination certificate

In compliance with the UK Health and Safety at Work Act and the Control of Substances Hazardous to Health Regulations, you are required to declare the sub- stances which have been in contact with product(s) you return to Watson-Marlow or its subsidiaries or distributors. Failure to do so will cause delays. Please ensure that you fax us this form and receive an RGA (Returned Goods Authorisation) before you despatch the product(s). A copy of this form must be attached to the outside of the packaging containing the product(s). Please complete a separate decontamination certificate for each product.

You are responsible for cleaning and decontaminating the product(s) before return.

Your name					Company
Address
Postcode/zip					Country
Telephone					Fax
Product type					Serial number
To speed the
repair, please
describe all
known faults
The product has ...		Been used	■	Not been used
	■

If the product has been used, please complete all the following sections.

If the product has not been used, please just sign this form.

Names of chemicals handled with product(s)

Precautions to be taken in handling these chemicals

Action to be taken in the event of human contact

I understand that the personal data collected will be kept confidentially in accordance with the UK Data Protection Act 1998.

RGA number

Signature Your position

Date

Please print out, sign and fax to Watson-Marlow Pumps at +44 1326 376009.

Watson-Marlow 520DuN IP66/NEMA 4X User Manual 105