Conditions of Use Check Sheet (Instructuion manual)
＊ For the safety of repair personnel, enter the relevant details in the check sheet below, and
attach it to the items to be repaired.
＊ Repair and inspection cannot be undertaken unless the relevant details are provided in this
check sheet.
＊ The information provided is protected under privacy legislation, and is used solely in
determining the causes of malfunctions, and in detoxification. This information will not be
disclosed to a third party.
Model Production number
1. Gases used (this information must be entered)
(1) Toxic to humans? Y/N (confirm with signature at bottom of sheet)
(2) Offensive smell? Y/N
(3) Type and name of gas
*
Some substances may require notification under the Occupational Safety and Health Act.
2. Usage
Operation: hours/day, months/year [] Continuous operation [] Intermittent operation
Details of use:
3. Malfunction details [] Abnormal noise [] Abnormal pressure [] Abnormal operation [] Oil leaks
Other symptoms
4. Reason for request [] Repair (overhaul) [] Regular inspection
5. Other
Your company name Person in charge
Address
Telephone Fax
Email
Dealer Person in charge
Telephone Fax
* If you do not deal directly with Ulvac, enter the name of your dealer.
6. Confirmation
Gases and substances used with this pump or equipment are not toxic to humans.
The pump and equipment are not contaminated with substances toxic to humans.
Signature Seal Date
＊ To avoid problems when transporting the pump, remove oil from the pump before
sending it.
＊ Send this check sheet to Ulvac’s Service Division (CS Center). Refer to the attached list of addresses.
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