NATEC Sensors GmbH – Sitz der Gesellschaft: Garching – Handelsregister: Amtsgericht München HRB 152634 Geschäftsführer: Günter Ries

Niels-Bohr-Straße 9-11, 85748 Garching, Telefon +49 89 307591-0, Fax +49 89 307591-29

Decontamination DeclarationFAX: +49 89 307591-29 orE-Mail: info@natec-sensors.com

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Due to legal requirements and to protect our employees, we ask you to sign the "Decontamination Declaration". Please take into ATTENTION: Without your complete declaration of decontamination we cannot start the working process! Please fill out, sign this form and send it to us in advance by fax or email or fasten a copy well visible at the OUTSIDE of the package.

delivery address: NATEC Sensors GmbH Niels-Bohr-Straße 9-11 D-85748 Garching

for questions: phone +49 89 307 591-0 fax +49 89 307 591-29 e-mail info@natec-sensors.com

Information to the sender (contact for queries):

company phone

contact person fax

street or postbox e-mail

address your order number

serial number:

Information to your device (please note all devices of the shipment):

model:

model: serial number:

model: serial number:

radioactive flammable toxic corrosive Information to your operation/application:

medium (please specify)

during process

final cleaning with

harmfull / others harmless irritant

during process

final cleaning with

Measurement for Humidity Pressure Torque Force Flow

NATEC Sensors GmbH – Sitz der Gesellschaft: Garching – Handelsregister: Amtsgericht München HRB 152634 Geschäftsführer: Günter Ries

Niels-Bohr-Straße 9-11, 85748 Garching, Telefon +49 89 307591-0, Fax +49 89 307591-29

Customer requests FAX: +49 89 307591-29 or E-Mail: info@natec-sensors.com

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Customer specifications (please mark the fields which you wish):

analyses modification check

ISO-calibration DAkkS-calibration as-found-calibration

maintanance repair

We would like NATEC Sensors GmbH to dispose defective devices and associated components (cables, plugs)

from this delivery for us.

Additional information, if applicable description failure:

Operating data:

customer application

measuring range

medium

temperature °C

viscosity mm²/s

density kg/m³

pressure bar gauge pressure absolute pressure differential pressure

Your reference date for the re-shipment:

Address for invoice/delivery address (if different from the sender):

phone company

contact person fax

street or postbox e-mail

address your order

We confirm to have filled out this declaration completely and truthfully to the best of our knowledge.

place / date name / department signature

Measurement for Humidity Pressure Torque Force Flow