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Equipment for Repair Declaration Instructions

Section 1: Vacuum pump and fluid type

Section 2: Condition of the vacuum pump

If your vacuum pump has been in contact with one or more if these substances A-Vac will not accept the delivery of the unit unless you decontaminate the unit and provide proof of decontamination. You must contact A-Vac Industries, Inc. before sending in such equipment.

Section 3: List of substances in contact with the vacuum pump

Section 4

Section 5: Declaration

All pumps received will be disassembled, if necessary, to evaluate the repairs needed. If you elect not to repair the pump after the evaluation, the pump will be returned in disassembled condition.

I have made reasonable inquiry and supplied accurate information on the declaration form. I have not withheld any information and have followed A-Vac Industries, inc. instructions for sending in equipment.

Clear Signature

Please note A-Vac Industries, Inc. will not begin any evaluation until a completed
declaration form has been submitted for each vacuum pump sent in for repair.


A-Vac Industries 1845 S. Lewis Street Anaheim, CA. 92805
800-747-2821 repairs@avac.com

Instructions for sending in equipment for repair

Before sending in your equipment, you must notify A-VAC Industries if the substances used (and produced) in the equipment can be hazardous. This information is fundamental to the safety of our employees and will determine the procedures employed to service your equipment. Complete the Declaration form and send it to AVAC Industries before sending in the equipment. It is important to note that this declaration is for A-VAC Industries internal use only and has no relationship to local, national, or international transportation safety or environmental requirements. As the person sending in the equipment, it is your responsibility to ensure compliance with applicable laws.


• Uncontaminated equipment means it has not been used or if it has only been used with substances that are not hazardous.

• Contaminated means it has been used with any substances classified as hazardous under OSHA Occupational Safety (29 CFR 1910).

• If your equipment has been used with radioactive substances, biological or infectious agents, mercury, polychlorinated biphenyls (PCB’s), dioxins or sodium azide, you must decontaminate it before you send it to A-VAC Industries, Inc. You must send independent proof of decontamination (for example, a certificate of analysis) to A-VAC Industries, Inc. with the Declaration form. Call us at 800-747-2821 for assistance if necessary.

• If your equipment is contaminated, you must either: Remove all traces of contamination (to the satisfaction of laws governing the transportation of dangerous/ hazardous substances) or properly classify the hazard, mark, manifest, and ship the equipment in accordance with applicable laws governing the shipment of hazardous materials. Note: Some contaminated equipment may not be suitable for airfreight.


1. Complete this form and submit through our website, include a copy of the form with the pump, if possible. Should you have any questions, contact repairs@avac.com or call 714-938-1300.

2. If the equipment is contaminated, you must contact your shipper to ensure that you properly classify the hazard, mark, manifest, and ship the equipment, in accordance with applicable laws governing the shipment of contaminated/ hazardous materials. As the person offering the equipment for shipment it is your responsibility to ensure compliance with applicable law. Note: Equipment contaminated with some hazardous materials, such as semiconductor byproducts, may not be suitable for airfreight – contact your transporter for advice.

3. Remove all traces of hazardous gases: pass an inert gas through the equipment and any accessories that will be returned to A-VAC Industries, Inc. Where possible, drain all fluids and lubricants from the equipment and its

4. Seal up all the equipment's inlets and outlets (including those where accessories were attached) with blanking flanges or, for uncontaminated product, with heavy gauge tape.

5. Seal equipment in a thick polythene/polyethylene bag or sheet.

6. If the equipment is large, strap the equipment and its accessories to a wooden pallet. If the equipment is too small to be strapped to a pallet, pack it in a suitable strong box.

7. Seal the original Declaration in a suitable envelope: attach the envelope securely to the outside of the equipment package in a clear weatherproof bag.