58
PRODUCT SERVICE REPAIR FORM
SENDER
Company name ............................................................................................................................................
Address
................................................................................................................................................
Phone no. ................................................................................................................................................
Contact person.............................................................................................................................................
PRODUCT TYPE (see product label)
DEVICE CODE ..............................................................................................................................................
S/N (serial number).......................................................................................................................................
DESCRIPTION OF PROBLEM
MECHANICAL
Wear parts .................................................................................................................................
Brekage/other damages .............................................................................................................
Corrosion ...................................................................................................................................
Other .........................................................................................................................................
ELECTRICAL
Connections, connector, cables ...................................................................................................
Operating controls (keyboard, display, etc.) .................................................................................
Elettronics ..................................................................................................................................
Other .........................................................................................................................................
LEAKS
Connections ...............................................................................................................................
Pump head ................................................................................................................................
NOT OR INADEQUATE FUNCTION/OTHER
.................................................................................................................................................
.................................................................................................................................................
.................................................................................................................................................
MOD 7.5 B1 Q
Ed. 1 - rev. 0 21/02/2012
OPERATING CONDITIONS
Location/installation description ..................................................................................................................
...................................................................................................................................................................
Chemical
................................................................................................................................................
Start-up (date) ............................................ Running time (approx. hours) ....................................................
REMOVE ALL THE LIQUID INTO THE PUMP HEAD AND DRY IT BEFORE PACKAGING IN ITS ORIGINAL BOX.
I declare that the dosing pump is free of any hazardous chemical.
Signature of the compiler
Company stamp
ENCLOSE THE PRESENT FORM TO THE DELIVERY NOTE
DATE
............................................
Summary of Contents for VMS MF
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