Sonics VCX750 User Manual download pdf (Page 22)

SONICS SAFETY CERTIFICATION FORM

Items being returned:

Please check only one item below:

___ The equipment was never used or exposed to any radiological, biological or

chemical agents and is safe to handle, use or dispose of.

___ The equipment was used but not in conjunction with or exposed to any

radiological, geological or chemical agents and is safe to handle, use, or dispose of.

___The equipment was used in conjunction with or exposed to radiological, biological,

or chemical agents and has been decontaminated, rendering it safer for handling, use,

or disposal.

Authorization

By accepting authorization to return the equipment listed above, the undersigned

assumes all responsibility and liability for radiological, biological and chemical

decontamination. Sonics reserves the right to refuse delivery of the equipment without

necessary documentation or where we determine they have not been properly

decontaminated. Sonics reserves the right to bill the customer for any and all costs

associated with the decontamination and/or disposal of the equipment we determine

was not properly decontaminated. In the event the equipment has been exposed to

radiological contamination, the signature of the Radioactive Safety Officer is required.

Print name: ___________________________________ RA # ___________________

Signature: ____________________________________ Date: __________________

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Sonics VCX750 User Manual Page 22