Edwards TCU 40/80 - Page 65

Return of Edwards Equipment- Declaration
(FormHS2)
/0
Return Authorization Number
You must:
• Know about all of the substances which have been used and produced in the equipment before you complete this
Declaration
• Read the Procedure (HS1) on the previous page before you attempt to complete this Declaration
• Contact your supplier to obtain a Return Authorization Number and to obtain advice if you have any questions
• Send this form to your supplier before you return your equipment
SECTION 1 : EQUIPMENT
Equipment model _
Serial Number Hours
Has the equipment been used, tested, or operated?
yes □ Go to Section 2 no □ Go to Section 4
FOR SEMICONDUCTOR APPLICATIONS ONLY:
Tool Reference Number
Process
Failure Date
Serial Number of Replacement TCU
SKCTION 2 : SUBSTANCES IN CONTACT WITH THE EQUIPMENT
Are any of the substances used or produced in the equipment
• Radioactive yesQ noQ
• Biologically active yesD noD
• Dangerous to human health and yesQ noD
safety?
If you have answered 'no' to all of
these questions, go to Section 4.
Your supplier will not accept delivery of any
equipment that is contaminated with radioactive
substances, unless you:
• Decontaminate the equipment
• Provide proof of decontamination
YOU MUST CONTACT YOUR SUPPLIER FOR
ADVICE BEFORE YOU RETURN SUCH
EQUIPMENT
SECTION 3 : LIST OK SUBSTANCES IN CONTACT WITH THE EQUIPMENT
Substance name
1
2
3
4
5
6
Chemical
symbol
Precautions required
(for example, use protective gloves, etc.)
Action required after spillage
or human contact.
SECTION 4 : RETURN IN! ORMATION
Reason for return and symptoms of malfunction:
If you have a warranty claim:
• who did you buy the equipment from ?
• give the supplier's invoice number
Print your name:
Print your organization:
Print your address:
Telephone number:
SECTION 5 : DECLARATION
Print your job title:_
Dale of equipment delivery: _
I have made reasonable inquiry and I have supplied accurate information in this Declaration. I have not withheld any
information. I have followed the Return of Edwards Equipment Procedure (HSl) on the previous page.
Signed:_
Date:
TCU 40/80 Temperature Control Unit 59