BSC BSV10 - Page 26

Check Sheet for Repair
Model
Serial
Purchase Date
Customers
Address
Person in charge
Tel No.
1 Request item
□Scheduled inspection repairing
□Trouble
Condition：□Ultimate pressure □Unusual sound □Irregular action
□Oil leak outside the pump □Others
Description of trouble：
□Others：
2 Service condition
 Whether the pump has been used： □Yes □No
Operational elapsed time：about
□24hr continuous operation □Intermittent operation
 Whether exposure to pollutants： □Yes □No
Name and Chemical formula pollutants：
Nature and character of pollutants：
Cleaning solvents and methods of pollutants：
3 Details of the request
□Warranty period □Repair quote please □Others：
4 Others：
Signature
Date
Notice:
1 Copy this sheet use as repaired.
2 Your request for repair and inspection may be refused if this sheet is not included with the pump.
3 Information of hazardous gas in this sheet must be correct and sufficient.