Varian TriScroll Dry Scroll 600 Série Manuel D'installation Et D'opération page 51

Request for Return Health and Safety Certification
1. Return authorization numbers (RA#) will not be issued for any product until this Certificate is completed and returned to a
Varian, Inc. Customer Service Representative.
2. Pack goods appropriately and drain all oil from rotary vane and diffusion pumps (for exchanges please use the packing
material from the replacement unit), making sure shipment documentation and package label clearly shows assigned
Return Authorization Number (RA#) VVT cannot accept any return without such reference.
3. Return product(s) to the nearest location:
North and South America
Varian, Inc.
Vacuum Technologies
121 Hartwell Ave.
Lexington, MA 02421
Fax: (781) 860-9252
For a complete list of phone/fax numbers see www.varianinc.com/vacuum
4. If a product is received at Varian, Inc. in a contaminated condition, the customer is held responsible for all costs incurred to
ensure the safe handling of the product, and is liable for any harm or injury to Varian, Inc. employees occurring as a result of
exposure to toxic or hazardous materials present in the product.
CUSTOMER INFORMATION
Company name:
Contact person:
Ship method:
Europe only: VAT Reg Number: ...........
Customer ship to: ....................................................................
PRODUCT IDENTIFICATION
Product Description
TYPE OF RETURN (check appropriate box)
❒ Paid Exchange
❒ Credit
HEALTH and SAFETY CERTIFICATION
V T
ACUUM ECHNOLOGIES CANNOT ACCEPT ANY BIOLOGICAL HAZARDS
MERCURY AT ITS FACILITY
❒ I confirm that the above product(s) has (have) NOT pumped or been exposed to any toxic or dangerous materials in a
quantity harmful for human contact.
❒ I declare that the above product(s) has (have) pumped or been exposed to the following toxic or dangerous materials in a
quantity harmful for human contact (Must be filled in):
Print Name................................................
Do not write below this line
Notification (RA) #: ................................... Customer ID #: ........................................ Equipment #: ............................................
Health and Safety Certification
......................................................................................................................................................................
Name: ......................................................................................
Fax: ..........................................................................................
Shipping Collect #: .................................. P.O.#: .......................................................
....................................................................
....................................................................
❒ Paid Repair
❒ Shipping Error
.
CHECK ONE OF THE FOLLOWING
PLEASE FILL IN THE FAILURE REPORT SECTION ON THE NEXT PAGE
Request for Return
Europe and Middle East
Varian S.p.A.
Via F.lli Varian, 54
10040 Leini (TO) – ITALY
Fax: (39) 011 997 9350
Customer bill to:
Varian, Inc. Part Number
❒ Warranty Exchange
❒ Evaluation Return
,
RADIOACTIVE MATERIAL
:
Signature ...................................................
August 2003 — Page 1 of 2
Asia and ROW
Varian Vacuum Technologies
Local Office
Tel:............................................................
E-mail: .....................................................
USA only: ❒Taxable
.................................................................
.................................................................
.................................................................
Varian, Inc. Serial Number
❒ Warranty Repair ❒ Loaner Return
❒ Calibration ❒ Other
,
ORGANIC METALS
Date ...............................
ISO
9001
R E G I S T E R E D
❒Non-taxable
,
OR