Yokogawa RotaMASS 3-Series - Manual (Page 14)

1. INTrOdUCTION
1-6 IM 01R04B05-00E-E 3rd edition July 30, 2010 -00 all Rights Reserved. Copyright © 2005, Rota Yokogawa
Receiver : Sender :
Delivery Note (for EU-Countries) Date :
Ref. REPAIR for serial no. __________________________
We are sending following type of article
via forwarding agent : Yusen Air ; Raunheim/Frankfurt
Item Article Unit Price Total Price
Type (MS-Code)
________________________________ € __________
€__________
Charges for airworthy packing
and delivery FOB
€___________
Total value € ___________
Value for customs purpose only € _________
(nominal value)
(current value)
Gross weight . _____________________kg
Net weight : _____________________kg
Customs Tariff No. : _____________________
Country og origin : Federal Republic of Germany
Delivery note 2-fold accompanis the goods
SPECIMEN Certificate
Company : ________________________ Address : ______________________
Department : ________________________ Name : ______________________
Telephone : ________________________ Fax : ______________________
The attached flowmeter :
Type : ______________________________ Order- or Serial No. ___________
has been operated with following liquids: ___________________________________________
Because the liquid is water-endangering toxic caustic flammable
we have
checked, that all cavities in the flowmeter are free from such substances
flushed out and neutralised all cavities in the flowmeter
Please check applicable description
We confirm that there is no risk to man or enviroment through any residual liquid containes in this flowmeter.
Date : _____________________ Signature : _______________________
Company stamp: