Agilent Technologies Eyesys Mini-B/A, Instruction Manual

Page: 37 / 42

23
Eyesys Mini-B/A Gauge Controller
RequestForReturnRevM.doc 22 March 2001 Pg. 1 of 2
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 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 Vacuum Technologies
121 Hartwell Ave.
Lexington, MA 02421
Fax: (781) 860-9252
Europe and Middle East
Varian S.p.A.
Via F.lli Varian, 54
10040 Leini (TO) – ITALY
Fax: (39) 011 997 9350
Asia and ROW
Varian Vacuum Technologies
Local Office
For a complete list of phone/fax numbers see www.varianinc.com/vacuum
4. If a product is received at Varian 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 employees occurring as a result of
exposure to toxic or hazardous materials present in the product.
CUSTOMER INFORMATION
Company name: ..………………….……..……………….………………………………..……………………...…………..….
Contact person: Name: ……………………………………..… Tel: ……………………….…...…………….….…...
Fax: …………………………….…...…..…… E-mail: ..……………………..…………..…..…..….
Ship Method: …………….……....…… Shipping Collect #: ………….…..………… P.O.#:………………….…......……….
Europe only : VAT Reg. Number: ………………..……………... USA only:
❐
Taxable
❐
Non-taxable
Customer Ship To: ………………………….……… Customer Bill To: …………………..……………...
……………..…………………... ..………………………………...
………………..………………... ..………………………………...
PRODUCT IDENTIFICATION
Product Description Varian P/N Varian S/N
TYPE OF RETURN (check appropriate box)
❐
Paid Exchange
❐
Paid Repair
❐
Warranty Exchange
❐
Warranty Repair
❐
Loaner Return
❐
Credit
❐
Shipping Error
❐
Evaluation Return
❐
Calibration
❐
Other ………………..
HEALTH and SAFETY CERTIFICATION
VARIAN VACUUM TECHNOLOGIES CANNOT ACCEPT ANY BIOLOGICAL HAZARDS, RADIOACTIVE
MATERIAL, ORGANIC METALS, OR MERCURY AT ITS FACILITY. CHECK ONE OF THE FOLLOWING:
❐
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: …………………………………. Signature: ……………...……………………. Date: ..…../..…../……
PLEASE FILL IN THE FAILURE REPORT SECTION ON THE NEXT PAGE
Do not write below this line
Notification (RA)#: ……………………….……….. Customer ID#: ……….…………. Equipment #: ……………………..
Request for Return Health and Safety
Certification