Appendix
9-3
Operating instructions ULTRAMAT 23 gas analyzer
C79000-B5276-C216-03
Returned deliveries form
()Repair ()Guarantee
Name of customer
Address
Person responsible
Delivery address
Telephone
Fax
e-Mail
Address for returned
delivery (if different from
above)
Customer (original)
Order No.
Siemens (original)
Order confirmation No.
Device name
MLFB No.
Serial No.
Designation of returned part
Fault description
Process data at point of
measurement
Operating temperature
Operating pressure
Composition of sample gas
Duration of use/
date put into service
Repair report
RH No.: Incoming date: Outgoing date: Technician:
Do not fill in this block; for internal use
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