2915 133
rd
Street West, Shakopee, MN 55379
Phone: 952-445-4841 Fax: 952-445-7615
e-mail:
mailto:[email protected]
web site:
www.gammavacuum.com
Return Material Authorization Form
Thank you for taking the time to complete this form. Please complete this form in word and return to Gamma Vacuum in
word, Adobe Acrobat format (.pdf), or via fax. The “tab” key moves between fields. Digital signatures are acceptable.
Assigned RMA:
Your Reference:
Company Information
Company Name:
Date:
Address:
Contact Information
Name:
Phone:
Primary E-mail:
Fax:
Web Site Address:
Return Information
Part Number:
Description:
Type of Product:
ION PUMP
ION PUMP CONTROLLER
OTHER
Serial Number:
Original Purchase Order:
Contaminant Status*:
HAS NOT BEEN EXPOSED
HAS BEEN EXPOSED
Your Reference:
Claim Status:
WARRANTY CLAIM
SERVICE REQUEST
SHIPPING ERROR
EVALUATION
OTHER
Reason for Return:
Additional Information:
Signature of Certifying Official
Name and Title of Certifying Official
* Contaminants to vacuum systems are defined as: any substance that, because of its properties, is not compatible with ultra-high vacuum (UHV)
operation. Some of these are: silicon (in the form of silicones), sulfur, cadmium, fluorine and chlorine. Contaminants have been determined by vapor
pressure curves and/or properties that are detrimental to the operation of UHV products.
** “Hazardous substance” means a chemical or substance, or mixture of chemicals or substances, which:
a.
is regulated by the Federal Occupational Safety and Health Administration under Code of Federal Regulations, title 29, part 1910, subpart Z;
b. is either toxic or highly toxic, an irritant, corrosive, a strong oxidizer, a strong sensitizer, combustible, either flammable or extremely flammable,
dangerously reactive, pyrophoric, a carcinogen, a teratogen, a mutagen, a reproductive toxic agent, or that otherwise, according to generally
accepted documented medical or scientific evidence, may cause substantial acute or chronic personal injury or illness during or as a direct result of
any customary or reasonably foreseeable accidental or intentional exposure to the chemical or substance. (Common examples: arsenic, cadmium,
gallium, cesium, mercury, radiation, etc.)
