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Grundfos CM Series Installatie- En Bedieningsinstructies pagina 21

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Please copy, fill in and sign this sheet and attach it to the pump returned for service.
Which media has the pump been used for: ______________________
In which application has the pump been used: ____________________
If possible please make a circle around the faulty part.
(In case of an electrical fault, please mark the terminal box.)
Please give a short description of the fault:
We hereby declare that this product is free from hazardous chemicals,
biological and radioactive substances.
_________________________
Date and signature
Safety declaration
Media and application
Fault description
_________________________
Company stamp
1
21

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