Emec ECL6 - Page 22

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PRODUCT SERVICE REPAIR FORM
SENDER
Company name ............................................................................................................................................
Address ................................................................................................................................................
Phone no. ................................................................................................................................................
Contact person.............................................................................................................................................
PRODUCT TYPE (see product label)
DEVICE CODE ..............................................................................................................................................
S/N (serial number).......................................................................................................................................
DESCRIPTION OF PROBLEM
MECHANICAL
Wear parts .................................................................................................................................
Brekage/other damages .............................................................................................................
Corrosion ...................................................................................................................................
Other .........................................................................................................................................
ELECTRICAL
Connections, connector, cables ...................................................................................................
Other .........................................................................................................................................
NOT OR INADEQUATE FUNCTION/OTHER
.................................................................................................................................................
.................................................................................................................................................
.................................................................................................................................................
MOD 7.5 B1 Q
Ed. 1 - rev. 0 21/02/2012
OPERATING CONDITIONS
Location/installation description ..................................................................................................................
...................................................................................................................................................................
Chemical ................................................................................................................................................
Start-up (date) ............................................ Running time (approx. hours) ....................................................
REMOVE ALL THE LIQUID AND DRY IT BEFORE PACKAGING IN ITS ORIGINAL BOX.
I declare that the product is free of any hazardous chemical.
Signature of the compiler Company stamp
ENCLOSE THE PRESENT FORM TO THE DELIVERY NOTE
DATE ............................................