Agilent Technologies Helium G8610 Series Field Installation Instructions page 35

Vacuum Products Division
Instructions for returning products
Customer Information Customer Information Customer Information Customer Information
Company:
Address:
Email:
Equipment Equipment
Equipment Equipment
Product Description:
Failure Description:
Type of Return Type of Return Type of Return Type of Return
☐ Non-billable ☐ Billable
☐ Exchange ☐ Repair
Health and safety Health and safety Health and safety Health and safety
The product has been exposed to the following substances:
(by selecting 'YES' you MUST complete the table to the right)
Toxic
Harmful
Corrosive
Reactive
Flammable
Explosive ( * )
*
Radioactive ( )
Biological ( * )
Oxidizing
Sensitive
Other Dangerous Substance
Goods Preparation Goods Preparation
Goods Preparation Goods Preparation
If you have replied YES to one of the above questions. Has the product been purged? ☐ YES ☐ NO
If yes, which cleaning agent/method:
Has the product been drained from oil?
I confirm to place this declaration on the outside of the shipping box.
I declare that the above information is true and complete to the best of my I declare that the above information is true and complete to the best of my I declare that the above information is true and complete to the best of my I declare that the above information is true and complete to the best of my knowledge and belief.
I understand and agree to the terms and conditions on page 2 of this document. I understand and agree to the terms and conditions on page 2 of this document.
I understand and agree to the terms and conditions on page 2 of this document. I understand and agree to the terms and conditions on page 2 of this document.
Name:
Position:
Date:
NOTE: If a product is received at Agilent which is contaminated with a toxic or hazardous material that was not disclosed, the NOTE
NOTE NOTE
customer will be held responsible customer will be held responsible customer will be held responsible for all costs incurred to ensure the safe handling of the product, and is liable for any harm or injury customer will be held responsible
to Agilent employees as well as to any third party occurring as a result of exposure to toxic or hazardous materials present in the
product.
Page 3 of 3
Agilent Part No.:
New PO # (Hard copy must be submitted with this form): _______________
☐ Upgrade ☐ Consignment/Demo
Substances Substances (please refer to MSDS forms) Substances Substances
* Agilent will not accept delivery of any product that is exposed to radioactive,
biological, explosive substances or dioxins, PCB's without written evidence of
decontamination.
Trade Name
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
☐ YES ☐ NO
Contact Name:
Tel:
Agilent Serial No.:
Type of Process (for which the equipment was used)
☐ Calibration ☐ Evaluation
Chemical Name Chemical Symbol
☐ YES ☐ NO
knowledge and belief. knowledge and belief. knowledge and belief.
Authorized Signature:
Fax:
Original Purchasing
Reference:
☐ Return for Credit
CAS Number
☐ NOT APPLICABLE
the
the the