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Grundfos SMART Digital S DDA-C Installatie- En Bedieningsinstructies pagina 50

Safety declaration
1. Safety declaration
Please copy, fill in and sign this sheet and attach it to the product returned for service.
Fill in this document using English or German language.
Fault description
Please give a short description of the fault and indicate if the diaphragm is damaged:
Declaration
We hereby declare that this product is free from hazardous chemicals, biological and radioactive substances:
Type designation (see nameplate):
Product number:
The product was used with the following dosing medium:
No dosing medium or water:
A chemical solution, name:
Date and signature:
Company stamp:
50
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