Siemens FX300 manual Form for copying to accompany a returned device

	SERVICE 7
SITRANS FX300

7.4.2 Form (for copying) to accompany a returned device

Company:

Address:

Department:

Name:

Tel. no.:

Fax no.:

Manufacturer's order no. or serial no.:

The device has been operated with the following medium:

This medium is:

water-hazardous

toxic

caustic

flammable

We checked that all cavities in the device are free from such substances.

We have flushed out and neutralized all cavities in the device.

We hereby confirm that there is no risk to persons or the environment through any residual media contained in the device when it is returned.

Date:

Signature:

Stamp:

Returning adress:

Siemens Flow Instruments A/S

Nordborgvej 81

DK - 6430 Nordborg

Att. Quality department E1-Ø21

CAUTION!

Disposal must be carried out in accordance with legislation applicable in your country.

06/2009 - SFIDK.PS.050.F2.02 A5E02100423 www.siemens.com/flow 65