Repair Request Sheet - Oval ALTI mass CA00A Instructions Manual

Company name
Address
Contact
Return (shipping)
Reason for return
(type of order)
Delivery date
Date of failure
Descriptions of
nonconformance (failure)
Unless the statements below are fully documented, returned equipment will not be processed.
◆
Model
Serial No.
Fluid name
Fluid density
Fluid temperature
Line pressure
Specification modification
Full scale flowrate
Pulse output ①
Pulse output ②
Analog output ①
Analog output ②
Sensor conditions
Type of cleaning material used for sensor unit
◆IMPORTANT
If sensor tubes leak, make sure that no process fluids remain in the housing. To provide a safe working
environment for our employees and engineers, this form must be filled in completely and accurately.
Unless accurate and precise information about the process fluids is given, returned equipment will NOT
be processed. Include your instructions and conditions accurately and in detail.
NOTE: To avoid misunderstanding, completely fill in this form.

REPAIR REQUEST SHEET

□ Repair □ Calibration □ Replacement □ Return
□ Others
□ Yes □ No
□ Mass □ Volume (fixed) □ Volume □ Pulse unit:
□ Mass □ Volume (fixed) □ Volume □ Pulse unit:
□ Mass □ Volume (fixed) □ Temperature □ Density
□ Mass □ Volume (fixed) □ Temperature □ Density
□ Tubes empty (no obstacles)
□ Sensor empty (no obstacles)
□ Tubes clogged / contaminated
Date of
installation
L -- 740 -- 28 -- E
□ O.C. □ Voltage
to
to
11