Customer Declaration Form

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Safety Data Sheets

Customer Declaration of Content

We would like your cooperation for the safe and smooth servicing or repair of your equipment at Alfa Laval. In order to safeguard our people and protect the environment, a customer declaration of content is required before a service job can be commenced in the Alfa Laval Service Centre.

*Required

Company name*

Site

Name of person making the Declaration*

Email address*

Position in organisation*

Equipment* High Speed Separator Decanter Centrifuge Heat Exchanger Heat Exchanger plates Other

Other [please specify what kind of equipment you have]

Equipment Serial Number/ Asset Number*

What Product(s) / Process is the equipment used on?*

Is the process / product hazardous or non-hazardous?* Hazardous [If hazardous selected then a Safety/ Material Data Sheet must be attached] Non-hazardous

Upload the safety data sheet for this product / process [.jpg,.png,.pdf]

The equipment has been: select all that apply* Emptied Flushed Cleaned Decontaminated Decontaminated LSA/NORM Other

Other

Upload certificate(s) of cleanliness / decontamination (if applicable) [.jpg,.png,.pdf]

Order number / Purchase order number if known

Serial Number

The serial number is located on the name plate on your unit. Depending on manufacturing date, it could be called Serial No., SN#, or similar.

Model Number

The help text for the Model number:""The product ""Type"" is located on the name plate of your unit. It could also be listed as ""Model No."", ""Model Type"", or similiar.