FrontierTM Centrifuge FC5714/FC5718/FC5718R/FC5816/FC5816R EN-4211.8 Table 8: Redemption form / Decontamination certificateEnclose this form with all returns of equipment and assemblies!The completed declaration about the decontamination is a prerequisite for the assumption and further processing of the return. If nocorresponding explanation is enclosed, we carry out decontamination with costs at your expense.Surname; last name: ___________________________________________Organization / company: ________________________________________Street: ______________________________________________________ZIP CODE: _____________ place:____________________Telephone: _____________ fax:____________________E-Mail: _____________________________________Pos. Crowd DecontaminatedobjectSerial number Description /Comment1234Are the parts listed above in contact with the following substances?Health endangering watery solutions, buffers, acids, alkalis:……………………..... Yes NoPotentially infectious agents: …………………………………………………………… Yes NoOrganic reagents and solvent: ……………………………………………………….. .. Yes NoRadioactive substances: ……………………………………………. α.. β.. γ… Yes NoHealth endangering proteins: ………………………………………………………….. Yes NoDNA: ……………………………………………………………………………………… Yes NoThese substances have reached the equipment/assembly? ………………………. Yes NoWhich one, if yes:________________________________________________________________Description of the measures for the decontamination of the listed parts:I confirm the proper decontamination:Company/Dept .________________________ Place and Date: ____________________________________Signature of the authorized person:________________________________________Please fill out in blockcapitals!