I. Product to be returned
i) Model No. of the product be returned
ii) Serial No. of the product to be returned
II. Pollution of the product to be returned
i) Applied process name
ii) Pollutant table
Pollutant
name
1
2
3
4
5
6
III. Reason for return
i) *Overhaul
ii) Contents of failure
IV. Person in charge and where to contact
Name :
Company name / plant name :
Address :
Telephone / FAX No. : TEL
Date of return :
PM10U
Return Notice Sheet
Chemical
Precaution on
symbol
Handling
*Failure
Action to be taken for accidental inhalation
*Other (
(signature)
FAX
Date :
.
or touch
)
Post :
EBARA
CORPORATION
P.47
.
.