Download SEFA-9-2010-Ductless.pdf - Scientific Equipment and ...
Download SEFA-9-2010-Ductless.pdf - Scientific Equipment and ...
Download SEFA-9-2010-Ductless.pdf - Scientific Equipment and ...
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—<strong>SEFA</strong> 9—<br />
DUCTLESS<br />
<strong>SEFA</strong> FORM 9-A - Application Questionnaire<br />
(See <strong>SEFA</strong> 9-<strong>2010</strong> §4.2.2 )<br />
Customer :<br />
Address:<br />
Contact: Phone: Date:<br />
Description of Application: (Customer to describe the process to be performed inside the hood including all equipment to be used inside hood)<br />
Chemical ID<br />
(ie., CAS#, EN#, etc.) Amount<br />
Completed by Customer Completed by Manufacturer<br />
Frequency/<br />
Duration<br />
Container<br />
Type—<br />
Covered/<br />
Open<br />
I, _______________________________ , in my capacity as __________________________________ of ___________________________________, certify to the best<br />
(Print Name) (Title/Position) (Customer Company)<br />
of my knowledge that all data <strong>and</strong> information submitted in this Application/<strong>SEFA</strong> Form 9-A, is truthful <strong>and</strong> accurate <strong>and</strong> that no material fact has been omitted.<br />
Evaporation<br />
Rate<br />
Concentration<br />
Temperature<br />
Maximum<br />
Potential<br />
Spill<br />
Volume<br />
Exp<br />
Reference Exp Limit Limit Type MSDS<br />
(Signature) (Date)<br />
©<strong>2010</strong> <strong>SEFA</strong>—4th Edition Desk Reference, Version 1.0<br />
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