Statement of Decontamination

In lieu of MSDS (Material Safety Data Sheet); We certify that the equipment shipped to Tencarva Machinery Company for repair has been decontaminated and is safe to handle.

This material is safe to handle

Company Name:

Branch Location:

Signed By:

Valid E-mail Address:

Referenced Order Number:

(Optional information to aid in the repair for elastomer and gasket selection)

Required: Please specify the chemical or fluid type that has been used by the equipment below.

Required: Please provide a brief equipment description.

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Tencarva Machinery Company