Doseuro D Series - Declaration of Reclamation by the Customer

XMPE0PCG125NST020 1st edition - 2020
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DECLARATION OF RECLAMATION BY THE CUSTOMER
Company:
Spokesperson:
Address:
No.
Telephone:
City:
Post code:
Fax:
Province:
E-mail:
Each pump must be clean, reclaimed and shipped carriage paid with the indications of the dosed liquid.
Each pump must arrive at the DOSEURO workshop with the valve unit disassembled from the pump and
fully reclaimed.
Before shipping the pump, contact the sales office to receive the AUTHORISED ACCEPTANCE NUMBER.
The form must be completed in all its parts, being an essential condition for carrying out maintenance work.
Cases for which the material is rejected to the sender carriage forward:
- Packaging and/or TD without AA number (Authorised Acceptance).
- Material not reclaimed or without the repair form.
- Valves still mounted on the pump and/or presence of reclamation fluid and/or chemical product in the
packaging.
GOODS DESCRIPTION
No. of
Pieces:
Dosing Pump:
Other:
Model:
Serial No.
Order No.:
Fluid treated:
FAULT DESCRIPTION AND OTHER INDICATIONS
Notes:
__________________________________________________________________________________________________________________
We declare under our responsibility that the pump delivered for repairs has been reclaimed by us following the procedure requested
by you. We believe that there is no residue inside that may cause a hazardous situation to the health of the operator in charge of
maintenance.
DECLARATION OF
RECLAMATION
SEAL AND SIGNATURE
__________________________________
DATE:
______________________________________
RESIDUAL RISK!