Grundfos DMH 25X Installatie- En Bedieningsinstructies pagina 683

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Please copy, fill in and sign this sheet and attach it to the pump returned for service.

We hereby declare that this product is free from hazardous chemicals, biological and radioactive

No media or water: _____________________________

A chemical solution, name: _________________________

In the case of an electrical or functional fault, please mark the cabinet.

Please give a short description of the fault

_______________________________________________________________________________

_____________________

Date and signature

Safety declaration

Fill in this document using English or German language.

Product type: ________________________________

Model number: _____________________________

(see pump nameplate)

Fault description

Please make a circle around the damaged part.

_____________________

Company stamp

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