FPZ SCL K05 MS-MOR Instructions Manual page 100

RMA – REPAIR REQUEST FORM and DECLARATION OF DECONTAMINATION
MACHINE / PRODUCT DATA
Type of machine / Model
Cause
Description of defect
DECLARATION OF DECONTAMINATION
•
For the safety of our employees and compliance with the legal requirements during handling of substances hazardous to health
and the environment, this declaration must be filled out completely and sent for each machine / product.
•
Without said declaration filled out completely, repair cannot be carried out.
•
The declaration must be sent with the shipping documents.
1. The machine / the product
has NOT come into contact with hazardous substances. In case of repair / disposal, there is no risk to people and the
environment. Go to point 3.
has come into contact with hazardous substances. Go to point 2.
2. Information on contamination
Type of system on which the machine is installed:
And it has come into contact with the following substances subject to the requirement of labelling or dangerous to health /
environment:
Trademark
The machine / product has been washed and cleaned on the outside. Specify the decontamination method used:
3. Legally binding declaration
The undersigned hereby declares that the details given on this form are true and complete.
APPLICANT'S DETAILS
Company name:
Street:
City:
Contact person:
E-mail / tel. no.
COMPLETION BY FPZ CUSTOMER CARE
RMA no.
NOTES
ENERGOEKONOM spol. s r.o., Wolkerova 433, CZ-250 82 Úvaly, Czech Republic, Tel.: +420 281 981 055, info@energoekonom.cz, www.energoekonom.cz
Fill out and return to: E-mail
Serial no.
Repair Warranty
Blocked
Other:
Chemical name Hazardous substance class
100 / 100
customercare@fpz.com
purchase
document no.
Repair Periodical maintenance
Motor failure
Noisy
Characteristics (e.g. toxic,
flammable, corrosive)
Date
Postal
Code
Province