Poulten Selfe and Lee Ltd
Customer
Issue 5.0
Date: 05 May 2022
Re-calibration Viscometer Checklist By: S. Sims
Please complete the following checklist.
Poulten Selfe and Lee Ltd will not be able to commence re-calibrating viscometers until this form is returned completed.
Company Name:
Contact Person:
Email:
Telephone:
Your order number:
Please state what substance(s) these viscometer(s) have been exposed to:
We hereby certify that these viscometer(s) have been decontaminated by approved methods and are safe for handling without PPE.
We confirm that these viscometers being submitted for calibration have not been exposed to radiation, bio-hazardous material or other hazardous contamination.
We understand that any contaminated (“dirty”) viscometers received by Poulten Selfe and Lee Ltd are liable for an additional cleaning fee prior to carrying out the recalibration.
Any such cleaning is subject to a risk assessment by the PSL Calibration Laboratory. A cleaning decision will be made depending upon the hazardous level of the substances that the viscometers were exposed to.
We understand that any viscometers received by Poulten Selfe & Lee Limited with unclear, faded or missing serial numbers will be fitted with a new different serial number prior to recalibration. Fees apply.
We understand that any damaged viscometers received by Poulten Selfe & Lee Limited will be repaired prior to recalibration. Fees apply.
I declare that the information given above is true and complete.
Signed:
Position:
Date:
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
Confirmation of current fees available from the Sales Desk. Thank you for your co-operation. Please return this form with your viscometers to:
Poulten Selfe and Lee Limited, Russell House, Burnham Business Park, Burnham-on-Crouch Essex CM0 8TE
Sales desk: sales@psl-rheotek.com
Laboratory Supervisor: Anna Milc
Email: anna.milc@psl-rheotek.com Tel: 01621 787100
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