Appendix; Return Form - ABB ProcessMaster FEM630 Operating Instructions Manual

FE M63 0 | E L EC TR OM AG N E T I C FLOWM E T E R | O I/F E M6 3 0-EN RE V. A
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Appendix

Return form

Statement on the contamination of devices and components
Repair and/or maintenance work will only be performed on devices and components if a statement form has been completed
and submitted.
Otherwise, the device/component returned may be rejected. This statement form may only be completed and signed by
authorized specialist personnel employed by the operator.
Customer details:
Company:
Address:
Contact person:
Fax:
Device details:
Type:
Reason for the return/description of the defect:
Was this device used in conjunction with substances which pose a threat or risk to health?
Yes No
If yes, which type of contamination (please place an X next to the applicable items):
biological
toxic
radioactive
Which substances have come into contact with the device?
1.
2.
3.
We hereby state that the devices/components shipped have been cleaned and are free from any dangerous or poisonous substances.
Town/city, date
Telephone:
Email:
Serial no.:
corrosive / irritating
explosive
Signature and company stamp
combustible (highly /
extremely combustible)
other toxic substances
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