Gow-Mac 21-080 User manual

Operating Manual
Read instructions before operating
Model 21-080
Mini Gas Leak Detector
Model 21-080: 100 - 240 VAC, 50/60 Hz
June 2023
Rev. 0
ALLOW UP TO 7 HOURS FOR FULL CHARGE.
FULL RUNTIME WILL RETURN AFTER
SEVERAL CHARGE/DISCHARGE CYCLES.
277 Brodhead Road, Bethlehem, PA 18017-8600 U.S.A. Tel: [phone]
!
IMPORTANT
For new instrument right out of the box or one
that has not been used for quite some time:

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
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GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
Contents
1-0 Model 21-080 Mini Gas Leak Detector .................................................................... 5
2-0 Specications ........................................................................................................... 5
3-0 Instrument Operation ............................................................................................... 6
3-1 User Interface Display and Controls .............................................................. 6
3-2 Operation .......................................................................................................... 8
4-0 Leak Checking Procedure........................................................................................ 9
5-0 21-080 Parameter Descriptions ............................................................................. 10
6-0 Troubleshooting...................................................................................................... 13
7-0 Charging the Cell / AC Operation.......................................................................... 14
8-0 Sensitivity................................................................................................................ 14
9-0 Replacement Parts List.......................................................................................... 15
NOTICE The information in this document is subject to change without notice.
GOW-MAC®INSTRUMENT CO. MAKES NO WARRANTY OF ANY KIND WITH REGARD TO THIS MATERIAL,
INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS
FOR A PARTICULAR PURPOSE. GOW-MAC®Instrument Co. shall not be liable for errors contained herein or
for incidental consequential damages in connection with the furnishing, performance, or use of this material.
This document contains proprietary information which is protected by copyright. All rights are reserved. No
part of the document may be photographed, reproduced, or translated into another language without the prior
written consent of GOW-MAC®Instrument Co.
The warranties made by GOW-MAC®Instrument Co. with respect to the product are voided if the product is
not used and serviced in accordance with the instructions in this manual.
Please protect yourself and your employees by following these operating instructions. We encourage our
customers to write or call for any additional information relative to the use or repair of this instrument.
Copyright© 2005-2023 by GOW-MAC®Instrument Co.
®GOW-MAC is a registered trademark of GOW-MAC Instrument Co., USA

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
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GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
1-0 Model 21-080 Mini Gas Leak Detector
1-1 The GOW-MAC®Model 21-080 Gas Leak Detector is supplied with a
3.5 ft. sampling probe and a power supply with 5 ft. cord.
1-2 The instrument contains a thermistor-type thermal conductivity detector (TCD),
diaphragm pump, and a printed circuit board containing all microelectronic devices.
1-3 The Model 21-080 operates on 100-240 VAC, 50/60 Hz and three (3) internal
rechargeable Ni-MH cells. An audible tone generator is incorporated with a speaker
output. The audio signal permits the technician to test for leaks without visually
scanning the meter.
2-0 Specications
Detector Thermal Conductivity Cell with Thermistors
Visual Readout LCD display featuring adjustable brightness
Peak hold with adjustable duration
Pump Diaphragm type
Line Voltage 100-240 VAC, 50/60 Hz
Cell Three (3) Rechargeable Ni-MH – 1.2 V, 1900 mAh, 1.9 Ah
Cell Life Approximately 20 hours; Recharged to 90% of capacity in 5
hrs.; Low battery indicator; Very low battery shutdown
Ranges Low: x1 High: x10
Adjustable sensitivity for low and high ranges
Response time 3 seconds
Zero Auto zero with drift elimination and manual override
Audio Signal Audible Alarm with adjustable setpoint and volume
Dimensions 7.5” L x 4.1" W x 3.0" H
(19.0 cm x 10.4 cm x 7.6 cm)
Weight Instrument: 1.2 lbs (0.52 kg)
Charger: 0.6 lbs (0.28 kg)
Features Flash memory for saving settings
Microprocessor controlled
Operating Temp. Range 70 °F ± 20 °F (21 °C ± 11 °C)
Accessories Testing to a NIST-traceable standard

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
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CAUTION
THE GOW-MAC GAS LEAK DETECTOR IS NOT
DESIGNED TO BE USED TO DETERMINE LEAKS
OF COMBUSTIBLE GASES. IT IS DESIGNED TO
DETERMINE LOW LEVEL LEAKS OF ANY GAS
HAVING A DIFFERENT THERMAL CONDUCTIVITY
THAN AIR. UTILIZING THIS PROPERTY, IT IS
THEREFORE NOT SPECIFIC TO ANY GAS OR
VAPOR. A COMBUSTIBLE GAS LEAK DETECTOR
SHOULD BE USED FOR THE DETERMINATION
OF COMBUSTIBLE GAS LEAKS IN POSSIBLE
HAZARDOUS CONDITIONS.
3-0 Instrument Operation
3-1 User Interface Display and Controls
HI
ZERO
LO
21-080 LEAK DETECTOR
MENU
1
3
2
4
5
6
Figure 3-1
3-1-1 LCD Display, 16 segments per row, two rows, controllable backlight
The display is the visual instrument output and user interface when the
control buttons are engaged. After power up and a 20 second warmup,
the default display shows X1 for the low gain sensing range and BATT
with 0 to 4 bars to indicate battery charge status. The bottom row shows
“Sensing” indicating that the instrument is operating in leak detection mode.
During the 20 second warmup period, all buttons including power are
disabled.

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GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
3-1-2 Power Button
 Pressbriey(shortpress)topoweron.Pressandholdfor1second(longpress)
topowero󰀨.UsethePowerbuttonwheninthemenutoscrollthroughinstrument
parameters.
3-1-3 ZERO/MENU Button
A short press of the ZERO/MENU button adjusts the output to zero which is neutral
signal from the detector. The signal direction is either positive, indicated on the
display as POS, or negative, indicated as NEG. The direction, POS or NEG,
is a function of the thermal conductivity of the leak compared to ambient air or
atmosphere. Gases, for example helium, with thermal conductivity greater than air
indicate as NEG. Gases, for example argon, with thermal conductivity lower than air
indicate as POS.
3-1-4 HI Button
Increase the instrument sensitivity or gain by a factor of 10. The range X10 is shown
on the display. Also use this button to increase a parameter value when in the menu.
3-1-5 Alarm/Backlight Button
 Pressthealarm/backlightbuttonbrieytoselectbetweenaudiblealarmONandOFF.
Use a long press of the alarm/backlight button to select between display backlight
ON and OFF. Backlight intensity is user-settable in the menu. Use the Alarm/
Backlight button when in the menu to scroll through instrument parameters.
3-1-6 LO Button
Decrease the instrument sensitivity or gain by a factor of 10. The range X1 is shown
on the display. Also use this button to decrease a parameter value when in the menu.
8
7
Figure 3-2
3-1-7 Sample Probe and Inlet Tubing
Wand with internal tubing through which the internal pump draws the gas sample.
The pump is energized and therefore drawing sample all the time that the 21-080
power is on. Use care to prevent the probe inlet from getting submerged in water and
to prevent dust ingress. The probe can be snapped into the clip on the side opposite
the power jack to enable one-handed operation.

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
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3-1-8 Reference Air Inlet
The hole next to the sample probe is connected to the detector. Ambient air that is
drawn through the detector is the reference for the sample measurement. The leak
magnitudesignalisgeneratedbythethermalconductivitydi󰀨erencebetweensample
picked up by the probe and ambient air pulled in at the reference air inlet.
Figure 3-3
3-1-9 Power Adapter Receptacle
Power for battery charging and for plugged in operation is connected to the power
adapter receptacle. Use only A/C power adapter/charger GOW-MAC part number
118-100 or the 21-080 can be damaged and its warranty voided.
3-2 Operation
3-2-1 Connect the power adapter plug to the receptacle on the side of the enclosure.
Connect the power adapter to a 100 to 240 VAC outlet. Allow up to 5 hours to charge
the internal battery.
3-2-2 Press the Power button. Short press switches power on and long press switches
powero󰀨.
3-2-3 Select LO or HI sensitivity.
LO range = X 1
HI range = X 10
NOTE: “Zeroing” appears on the display after selection of HI or LO, after exiting the
menu,andanytimetheMENU/ZERObuttonisbrieypressed.Zeroingindicatesa5
to 10-second period of zeroing the signal. Completion is indicated when “zeroing” is
replaced by “sensing”.
3-2-4 SignalzerocanbedoneatanytimebybrieypressingMENU/ZERObutton
(extended press of the MENU/ZERO button is the way to enter the 21-080 menu).
3-2-5 Activate the audible alarm to supplement the visual output on the display.
3-2-6 Areas to be tested must be free of oil, grease, paint, water, and other contaminants
that might mask a leak or be drawn into the sampling probe.
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GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
 3-2-7 Tolookforaleak,movethesampleprobeopeningtothetargetareaortting.
NOTE: to locate the smallest leaks on HI range, the user should wear a glove on the
hand holding the probe to isolate the user from the probe inlet.
3-2-8 Leak indication. Segments on the bottom row of the display appear when a leak
is detected. The number of segments from 1 to 16 illuminate in proportion to the
intensity of the signal which is proportional to the concentration of the sampled gas.
4-0 Leak Checking Procedure
CAUTION
EXTREME CARE SHOULD BE EXERCISED
WHEN THE PROBE IS USED AROUND
ELECTRICAL HEATERS, SWITCHES, ETC.
4-1 Care must be exercised to avoid exhaling of breath near the probe or instrument
housing itself. The carbon dioxide (CO2) exhaled can be drawn into the sample probe
or the reference air inlet of the leak detector and falsely indicate a leak.
4-2 If helium (He) is being checked, a leak indicates polarity NEG (negative). Most other
gases or vapors indicate POS (positive polarity). Polarity is on a function of the
sample (leak) gas's thermal conductivity relative to ambient air reference.
4-3 When checking for leaks, it is IMPERATIVEthatttingsorsuspectedleakareas
are DRY. If the area has previously been checked with a water based bubble type
solution and HAS NOT BEEN DRIED, low readings, as well as possible detector
contamination may occur. For example, the thermal conductivity of water vapor
willcounteractthesignalfromheliumleaks.Thenete󰀨ectwillbefalselowleak
indication.
MOISTURE
DO NOT ALLOW MOISTURE TO BE DRAWN
INTO THE PROBE!
4-4 Using the probe, carefully move the tip around and over suspected joints, seals,
seams, or other areas where leaks occur. The probe must be moved slowly to detect
small leaks.
4-5 A leak is indicated by illumination of display segments and by sound if the alarm
is enabled. Remove the probe from the area, allow the segments to settle to zero
(rezero if necessary), and return probe to the suspected location to verify the leak.
4-6 For more detailed information on leak detector sensitivity, refer Section 8-0
Sensitivity.

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
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5-0 21-080 Parameter Descriptions
The 21-080 parameters are functions that can be changed in the menu.
21-080
Parameter Funcon Available range Default seng
Alarm volume Audible alarm sound
level 0 – 100 % 50 %
Alarm type Alarm enable and type
of tone
Select constant
tone, beeping
tone, or alarm o 
constant
Alarm set point Set threshold for
alarm sound
1 – 16 segments
of the display 10
Pump speed Air ow intake by the probe 0 – 100 % 50 %
Backlight LCD display backlight brightness 0 – 100 % 50 %
LO range
sensivity
Adjust sensivity within low
range 0 – 100 % 50 %
HI range
sensivity
Adjust sensivity
within high range 0 – 100 % 50 %
Peak hold on-o
The high signal
(maximum illuminated segments)
of a transient leak is marked by *
on the display
On or o on
Peak hold delay Time that the peak
indicator * remains displayed 0 to 999 seconds 20 sec
Auto zero on-o
Connuous adjustment of long-
term zeroing
(while signal is below 3 bars)
On or o on
Auto zero speed Rate of connuous adjustment 0 – 100 % 50 %
Restore sengs
Restore factory default sengs
Must
select YES and con  rm
YES to restore.
Yes or no no
Summary of 21-080 user-seable parameters

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GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
A long press of the ZERO/MENU button opens the menu of user-settable operating
parameters. Leak detection output is disabled when in the menu. One must scroll through
the 21-080 parameters described in Section 5 to make a change. Scroll using the Power
button and the Alarm/Backlight buttons. When the parameter shows in the display, use the
HI and LO buttons to change the value. The factory default settings can be restored with
one of the menu options. A parameter setting change must be saved with a short press of
the MENU/ZERO button or will not save. Exit menu with long press of the MENU/ZERO
button. The 21-080 exits the menu automatically after about 1 minute of no activity in the
menu. The 21-080 performs a signal zero automatically upon menu exit.
5-1 Alarm Volume
Sets the alarm sound level. The level increases with a higher % setting.
5-2 Alarm Type
Select either a constant tone or a beeping tone with frequency that changes wit the
leak size; faster for larger leak.
5-3 Alarm Set Point
Set the threshold for alarm to sound as the leak size increases.
5-4 Pump Speed
   Thefrequencyofthepumpdiaphragmstrokeisadjustable.Thisa󰀨ectstheairow
rate through the probe and detector. Higher speed causes a faster response time to
a leak but decreases concentration of sampled gas..
5-5 Backlight
Adjust the intensity of the LCD display backlight. Higher backlight setting reduces
time the instrument can run on battery between charges.
5-6 Range Sensitivity
HI range is 10 times more sensitive to leaks than LO range. Within each of LO
andHIrange,thesensitivitycanbefurtheradjusted.Thetradeo󰀨forincreasing
sensitivity is that the output becomes noisy and must be zeroed more frequently to
be useful.

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
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5-7 PeakHoldOn-O󰀨
The high point of a transient leak indication can be marked on the display with an
asterisk * when peak hold ON is selected. The 21-080 is not a quantitative device,
however leak peak levels indicate relative concentrations of the target leaking gas.
5-8 Peak Hold Delay
Set the duration that the peak hold marker (*) remains on the display. A peak hold
marker is overwritten if the next leak is detected before the end of the hold period.
5-9 AutoZeroOn-O󰀨
The 21-080 is in a “zero” state when no display segments are lit; when the detector
outputequalsareferenceoutputthatissavedinthermware.Thedetectoroutput
drifts due to environmental conditions especially temperature, drafts, and ambient
air (the reference part of the detector output). As the detector output drifts, the saved
reference must be made to match the detector output to keep the signal zeroed. This
forced matching happens when Auto Zero is ON.
5-10 Auto Zero Speed
Auto Zero Speed is active only when Auto Zero is ON. The zeroing must be fast
enoughtokeepthedisplaysegmentsfromlighting,yetnottoofasttoa󰀨ectleak
detection. That balance is controlled by Auto Zero Speed. The Auto Zero Speed
isthespeedatwhichthezeroreference(savedinrmware)ismadetomatchthe
detector output.
The Auto Zero only runs when there are less than 3 lit segments.
If no segments are lit for 10 consecutive 100 millisecond periods, then the zero
reference(savedinrmware)ismadetomatchthedetectoroutput.
If 1 or 2 segments are active, a counter is incremented or decremented (depending
on whether a pos or neg signal) every 100 milliseconds. If the counter goes above
the threshold value of Auto Zero Speed, then the zero reference is incremented
towards the detector value. This continually repeats until the zero reference equals
the detector output.

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GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
5-11 Restore Settings
The settings for all menu parameters can be reset to factory default values by
selecting YES on the RESTORE SETTINGS menu page. The user will be prompted
toconrmchangetodefaultsettings.
5-12 Software Revision
The last page of the menu scroll shows the installed software revision.
6-0 Troubleshooting
REMOVE AC POWER ADAPTOR FROM OUTLET
6-1 Instrument will not zero
6-1-1 Check for clogged probe or obstructed reference inlet.
6-1-2 Check instrument settings. Reset to factory defaults if necessary.
6-2 Response time has increased
6-2-1 Diaphragm on pump is leaking. Replace diaphragm.
6-2-2 Sample line (probe) has become punctured. Replace probe assembly.
6-3 Sensitivity has decreased
6-3-1 Sample line (probe) has been punctured. Replace probe assembly.
6-3-2 Probe assembly leaking. Replace probe assembly.
6-3-3 Pump operating improperly. Replace pump.
6-3-4 Check instrument settings. Reset to factory defaults if necessary.
6-4 If repair service is needed, contact our repair department at: [email protected]
or scan the Q code for our website and click on Services Tab and the Repair Tab for
further instructions.

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
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7-0 Charging the Cell / AC Operation
 7-1 TheModel21-080MiniGasLeakDetectoroperateso󰀨aninternalrechargeablecell.
When the cell is discharged, the instrument may continue to be run while the light is
ashing,howevertheunitwillshutdownautomaticallywhenthecellisdischarged
to a point that it will no longer operate correctly. When using the supplied +9 Volt AC
adaptor, the instrument will operate and slowly recharge the cell. To fully charge the
cell,switchtheinstrumentpower“o󰀨”andallowtochargeforaapproximately6to7
hours.
8-0 Sensitivity
The 21-080 leak detector user is encouraged to read ASTM standard ASTM E2024/
E2024M-11 Standard Practice for Atmospheric Leaks Using a Thermal Conductivity Leak
Detector.
8-1 Recommended technique for sampling with a leak detector probe. The probe tip shall
be held not more than 1 mm (0.04 inch) from the test surface and moved not faster
than 20 mm/sec (0.8 inch/sec). To obtain the best approximate leak measurement,
the sample gas (the leak), reference gas (ambient atmosphere) scanning rate
and distance should be identical to the conditions for calibrating the leak detector,
explained as follows.
8-2 Calibration of the GOW-MAC 21-080 leak detector. Use a calibrated leak that can
belledwiththesamegasastheleak.GOW-MACveriesthesensitivityofitsleak
detectors by testing with a NIST-traceable calibrated helium leak. This is a service for
newandusedinstruments.Thecertied21-080sensitivityis10%offull-scalemeter
deectiononHIrangewithsensitivitysetto50%.
 8-3 Minimumdetectablelevelsaredeterminedbythethermalconductivitydi󰀨erence
between the reference and sample gases. Reference gas is the ambient
atmosphere, which is normally air. Sample gas is the leak picked up by the probe.
Botharedrawnacrossthermistorsinthedetector.Thegasowcoolsthethermistors
atdi󰀨erentrateswhichchangestheirrespectiveresistances.Theresistancechange
is processed into the leak indication segments on the display. Minimum detectable
leaks for a few gases are generally according to this table.
Sensitivity Chart
Minimumleakraterequiredtoproduce10%deectionoffullscale
Helium (He) 1.0 x 10-5 cc/sec 0.012 cu ft/yr
Argon (Ar) 1.0 x 10-4 cc/sec 0.110 cu ft/yr
Carbon Dioxide (CO 1.0 x 10-4 cc/sec 0.123 cu ft/yr
Helium (He) 1.0 x 10-4 cc/sec 0.123 cu ft/yr

15
GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
9-0 Replacement Parts List
Part No. Description
021-5-SS-1 Thermal conductivity detector
021-9-1 Probe assembly, mini leak detector, complete
133-152 Pump, vacuum micro, 3 V dc
119-126 Cell, 1.2 V / 1.9 Ah, nickel metal hydride,
rechargeable, 3 cells per instrument
118-100 A/C power adapter/charger, 100 to 240 VAC input

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
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GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
Warranty
4/12/23
kj
ALL INSTRUMENTS SOLD BY GOW-MAC®INSTRUMENT CO. ARE WARRANTED FOR A
PERIOD OF ONE YEAR AGAINST DEFECTS IN MATERIALS AND WORKMANSHIP. THE TERMS
OF THIS WARRANTY ARE AS FOLLOWS:
1. The warranty period begins with the shipping date of the equipment to the original purchaser.
2. Certain parts such as batteries, fused, glass accessories, septa, columns, etc., are expendable in normal
use, and their service life is unpredictable. Such items are not covered by this warranty.
3. Filaments of thermal conductivity detectors are not covered by this warranty.
4. Hydrogen Palladium Tubes are not covered by this warranty.
5. All requests for service or repair under this warranty must be received within the warranty period by
GOW-MAC®or its authorized representative. All repairs are made at GOW-MAC plants or at the
office of authorized representatives.
6. All repairs, adjustments, and other services under this warranty shall be performed free of charge to
the purchaser. However, warranty service and repairs shall be limited to equipment malfunctions
which, in the opinion of GOW-MAC®, are due or traceable to defects in original materials or
workmanship. Instrument malfunctions caused by abuse or neglect of the equipment are expressly not
covered by this warranty.
7. Instrument parts which have been repaired or replaced during the warranty period are themselves
warranted only for the remaining unexpired portion of the original one-year warranty.
8. Repairs, adjustments, and service performed after expiration of the one-year warranty period shall be
charged to the purchaser at the then current prices for parts, labor, and transportation.
9. This warranty attaches to the equipment itself and is not limited to the original purchaser. Unexpired
portions of the warranty are thus transferable to subsequent owners.
10. GOW-MAC®expressly disclaims any liability to users of its products for consequential damages of
any kind arising out of or connected with the use of its products.
11. Except as stated in Sections 1 through 8 above, GOW-MAC®makes no warranty, expressed or implied
(either in fact or by operation of law), statutory or otherwise; and, except as stated in Sections 1 through
8 above, GOW-MAC®shall have no liability under any warranty, expressed or implied (either in fact
or by operation of law), statutory or otherwise.
12. Statements made by any person, including representatives of GOW-MAC®which are inconsistent or
in conflict with the terms of this warranty shall not be binding upon GOW-MAC® unless reduced to
writing and approved by an officer of the Company.
13. This warranty shall be governed by the laws of the Commonwealth of Pennsylvania.

GOW-MAC Instrument Co. Model 21-080 Gas Leak Detector Rev. 0, 0623
18
Health and Safety Declaration for the Return of GOW-MAC Instrument Co. Equipment
In order to protect our employees from exposure to various hazards, the following
statements and/or questions MUST be answered by you. Fill out this document
in its entirety and either fax or e-mail it to GOW-MAC Instrument Co., Attn:
Repair Dept, BEFORE returning the product.
The instrument/part being returnedwill not be accepted into GOW-MAC’s facility
until we receive this completed document, along with a PO or Credit Card. Once
approved for return by our Chemical Safety Officer, a Return Materials
Authorization (RMA) number and shipping instructions will be issued. All
applicable regulations should be followed when returning instrumentation,
and/or parts.
Customer to Record the Following:
Model # / Part # ________________________________
Serial #:____________________
Service Technician spoken to:
Today’s Date:
IF THIS FORM IS NOT APPROVED BY OUR CHEMICAL SAFETY OFFICER, THE INSTRUMENT/PART WILL NOT BE PERMITTED INTO
OUR FACILITY FOR SERVICING!
A] Brief explanation of issue:_______________________________________________________________________________________
B] Briefly list the application(s) for which the instrument/part was used, as well as any and all chemicals, gases, and/or materials
analyzed and their concentrations. ( Must be filled in ): ________________________________________________________________
C] Is there the possibility of internal or external contamination on or in this instrument/part?
Yes –see below No –proceed to D.
Please check the appropriate box.
Chemicals or Substances That Are Hazardous to Health
Blood, Body Fluids, (e.g. Urine, Secretions), Pathological Specimens
Regulated Medical Wastes
Infectious Substances or other Bio-Agents (e.g. Protein, Enzymes, Antibodies)
Radioactive Isotopes used in the area. Detail type (ECD, Isotopic Labels, etc) and Activity in Micro Curies
Biodegradable Material That Could Become Hazardous
Other Hazards
If any of the above boxes are checked the following statements and/or questions must be answered.
1. Specifically describe where (on or in) the instrument/part there could be any residual contamination (for example: blood spill on the
surface).
2. Provide details of these hazards. Include names, Material Safety Data Sheets (MSDS), and concentration of contaminants, where
possible.
3. Describe the method of decontamination used. Attach Procedure.
D] I declare that the above information is true and complete to the best of my knowledge. I acknowledge that any inconsistencies between
the condition of the instrument and the statements made on this form will delay the repair process.
Authorized signature Date:
Name (Printed) Phone number:
Company name: Fax number:
Shipping address: ___________________________
City: State/Country: Zip :
E-mail address: _
BEFORE item can be shipped, fax completed form to: [phone] or e-mail it to: [e-mail]
For GOW-MAC Use Only: Signed: Date _/ /
□ Passed Safety Inspection. OK to proceed to Repair Dept. Chemical Safety Officer Comments: ( ) None
□ Failed safetyInspection. DO NOT proceed to Repair Dept. RMA No: ( ) On Back >>>>
REP-005
Health-Safety Declaration Doc –ONLINE
Rev.7 1/28/2022, kj