ISOMAG ML 110 - INSTRUMENT RETURN FORM DETAILS; Sensor and Converter Information; Cleaning and Medium Information

For the return photocopy these pages in A4 format
Sensor: MS______________ Serial number:
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Failure description:
_______________________________________________
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Converter: ML______________ Serial number:_______
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Failure description:
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We herewith confirm that above mentioned sensor has been cleaned and it is
therefore free of any liquid and/or solid wa
stes of the measuring medium and/or
cleaning medium. Any eventually remaining wastes are:
Measuring medium:
________________________________________________
__________________________________________________________________
_________________________________
_________________________________
harmful/
injurious no yes; i
n this case, safety
sheet must be attached!
Sensor cleaned with:
_______________________________________________
_________________________________________________________________
________________________________________________________________
_________________________________________________________________
Further notes:
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___________ ________________
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Date Company stamp e-mail address
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Signature of person in charge
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We herewith confirm that above mentioned sensor has been cleaned and it is
stes of the measuring medium and/or
________________________________________________
__________________________________________________________________
_________________________________
n this case, safety
specification
sheet must be attached!
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(for questions)