Fluid Components International ST75_ST75V - Manual (Page 36)

FLUID COMPONENTS INTERNATIONAL LLC ST75/ST75V MASS FLOW
This page is subject to proprietary rights statement on last page 36 Doc. No. 06EN003368 Rev. C
Return Authorization Request
1. Return Customer Information
Returning Company’s Name:__________________________________ Fax # __________________________
Return Contact Name: ______________________________________ Phone # ________________________
Email Address: _______________________________________________________________________
2. Return Address
Bill To: ______________________________________ Ship To: ______________________________________
____________________________________________ _____________________________________________
____________________________________________ _____________________________________________
____________________________________________ _____________________________________________
3. Return Product Information
Model No: ___________________________________ Serial No(s): ___________________________________
Failure Symptoms (Detailed Description Required): _________________________________________________
____________________________________________________________________________________________
What Trouble Shooting Was Done Via Phone or Field Visit by FCI: ____________________________________
____________________________________________________________________________________________
FCI Factory Technical Service Contact: ___________________________________________________________
4. Reason For Return Sensor Element Electronics As Found Testing Credit
Recalibrate (Old Data) Recalibrate (New Data) Other
(Note: A new Application Data Sheet (ADS) must be submitted for all recalibrations and re-certifications)
5. Payment Via Faxed Purchase Order
(Note: A priced quotation is provided for all Non-Warranty repairs after equipment has been evaluated.
All Non-Warranty repairs are subject to a minimum evaluation charge)
Sensor Element Protector Requested Electronics Anti-Static Bag Requested
Decontamination Information ! This Section Must Be Completed !
Exposure to hazardous materials is regulated by Federal, State (California), County and City laws and regulations.
These laws provide FCI’s employees with the “Right to Know” the hazardous or toxic materials or substances in which
they may come in contact while handling returned products. Consequently, our employees must have access to data
regarding the hazardous or toxic materials or substances which the equipment has been exposed to in your process(es).
Accordingly, prior to returning your instrument for evaluation/repair, please read then sign the certification below and
thoroughly comply with the applicable instructions.
I certify that the returned item(s) has(have) been thoroughly and completely cleaned. If the returned item(s) has(have)
been exposed to hazardous or toxic materials or substances, the undersigned attests that the attached Material Safety
Data Sheet(s) (MSDS) which cover said materials or substances are complete and accompany the returned item(s).
Furthermore, I understand that this Certificate, or providing a MSDS, shall not waive our responsibility to provide a
neutralized, decontaminated, and clean product for evaluation/repair to FCI. Cleanliness of a returned item or the
acceptability of the MSDS shall be at the sole discretion of FCI. Any item returned which does not comply with these
instructions shall be returned to your location Freight Collect and at your risk.
Process Flow Media ___________________________________________________________________________________
Authorized Signature ________________________________ Date _____________________________________________
RA #___________
1755 La Costa Meadows Drive, San Marcos, CA 92078-5115 USA
760-744-6950 / 800-854-1993 / Fax: 760-736-6250
Web Site: www.fluidcomponents.com / E-mail: [email protected]
FCI Document No. 05CS000004A