Pump Warranty Return & Safety Declaration
As part of the New Zealand Hazardous Substances & New Organisms Regulations and the Health and Safety at Work regulatory framework – all goods returned to Argon Distributors Ltd, it will be placed into quarantine until a declaration has been completed stating that the goods are safe to handle.
Company
Attention
Your PO#
Phone / Email
Repair Reference No
Model(s) / Type
Serial Number(s)
What is the pump used for? please provide details of any hazardous substances and handling precautions to be considered in handling this equipment
Substances / Products pumped with this pump
MSDS is attached / has been provided prior to shipping or is attached
Yes
Personal Protective Equipment normally worn when using this product / pump
Declaration - I declare that I have taken all responsible steps to ensure the above statements
*
The accuracy of the above information
The items being shipped are secured and safe for transport
The pump/product supplied is free from any known hazards or risk
Customer representative signature
Customer representative name
Customer representative position
Date
-
Month
-
Day
Year
Date
Submit Warranty Return
Submit Warranty Return
Should be Empty: