DANIELTM Measurement and Control, Inc.

Returned Material Authorization

Repair Form for Used Equipment

Including Decontamination/Cleaning Statement

A Return Material Authorization (RMA) number must be obtained prior to returning any equipment for any reason. Download the RMA form from the Support Services web page by selecting the link below.

http://www2.emersonprocess.com/EN-US/BRANDS/DANIEL/SUPPORT-SERVICES/Pages/Support-Services.aspx

1.Return Material Authorization (RMA) Number_________________________________

2.Equipment to be returned:

Model Number ___________________Serial Number__________________________

3.Reason for return:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Decontamination/Cleaning Fluids Process

A. List each substance in which the equipment was exposed. Attach additional documents if necessary.

Common

CAS# if

Used for Hazardous

EPA Waste Code

Name

Available

Waste (20 CFR 261)

if used for hazardous waste

 

 

 

 

 

 

[ ] Yes

[ ] No

 

 

 

 

 

 

[ ] Yes

[ ] No

 

 

 

 

 

 

[ ] Yes

[ ] No

 

 

 

 

 

 

[ ] Yes

[ ] No

 

 

 

 

 

 

[ ] Yes

[ ] No

 

 

 

 

 

 

[ ] Yes

[ ] No

B. Circle any hazards and/or process fluid types that apply:

 

 

 

InfectiousRadioactiveExplosivePyrophoricPoison Gas

 

Cyanides

Sulfides

Corrosive

Oxidizer

Flammable

Poison

Carcinogen

Peroxide

Reactive-Air

Reactive-Water

Reactive-Other (list):

 

Other Hazard Category (list):

C. Describe decontamination/cleaning process. Include MSDS description for substances used in decontamination and cleaning processes. Attach additional documents if necessary.