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Fci return authorization request, Document 1 – Fluid Components International RF83 Manual Customer Service User Manual

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Doc. No. 003147 Rev. B

C - 3

Model RF83 Flow Switch

APPENDIX C - CUSTOMER SERVICE

FLUID COMPONENTS INTL

Decontamination Information

Exposure to hazardous materials is regulated by Federal, state (California), County and City laws and regulations. These
laws provide FCI's employees with the right to know the hazardous materials with which they come in contact while handling
our products. Consequently, our employees must have access to data regarding the hazardous materials which the equipment
has been exposed to in your process(es). Accordingly, prior to returning your instrument for repair, please sign the certification below and
thoroughly comply with the instructions, if applicable.

I certify that the item(s) has (have) been thoroughly and completely cleaned and if the item(s) has (have) been exposed to or
contacted by a hazardous material, hazardous substance or toxic materials or substances that the undersigned can assure the returned item(s) has
(have) been thoroughly and completely decontaminated and neutralized of such substances and contamination. I have also attached a
Material Safety Data Sheet (MSDS) which covers all hazardous material, hazardous substance or toxic materials or substances
exposed to or contacted by the instrument. Furthermore, I understand that this Certificate, or providing a MSDS, shall not waive our
responsibility to provide a neutralized, decontaminated, and clean product for repair to FCI.

Authorized Signature

Date

Cleanliness of a returned item or the acceptability of the MSDS shall be at the sole discretion of FCI.
Any returned item which does not comply with these instructions shall be returned to you at your expense.

Model Number(s)

Serial Number(s)

Sending:

Electronics only

Sensor only

Complete unit

Number of units

Failure Symptoms

Troubleshooting done in the field by

FCI representative

or by Customer

:

Action to be taken by FCI

(Note: Re-calibration/Re-certification requires the completion of a new Application Data Sheet)

Process Flow Media:

Who is your FCI factory technical contact:

Name of Company Returning Hardware

Contact Name:

Phone #

Fax #

Customer Bill to Address:

Ship to:

Purchase Agent Contact:

Phone #

Fax #

Customer Information

Document 1.

FCI RETURN AUTHORIZATION REQUEST

Product Information

Note: FCI will charge a $100 minimum handling fee on all non-warranty evaluations.

Have you contacted your local FCI representative for assistance?

yes

no