Micro Motion Fisher-Rosemount RFT9709, Instruction Manual

Page: 64 / 74

RMA number:
Equipment to be returned:
By:
Job title:
Company name:
Phone number:
FAX number:
Date:
Decontamination/Cleaning Statement
Substance 1 Substance 2
Common name of
substance exposed to
equipment
Chemical abstract number
see 40 CFR 261*
(if applicable)
Hazardous waste number/
hazard code
see 40 CFR 261*
(if applicable)
Describe decontamination
process, list substances
used for decontamination
and cleaning
(Please print) (Signature)
IMPORTANT:
• RMA number must be noted on the shipping package.
• Two copies of this DECONTAMINATION/CLEANING STATEMENT and Material Safety Data Sheet (MSDS), if
required, must be included — one attached to the outside of the box and one inside of the shipping package.
Ship equipment to: Micro Motion, Inc.
6930 Winchester Circle, Dock #6
Attn: RMA #________
Boulder, CO 80301
*Refer to Micro Motion Equipment Return Requirements (page 55).
I hereby certify that the above listed equipment being returned is clean and has been decontaminated of
any hazardous substances, and poses no health or safety risks. Furthermore, it is my understanding that the
equipment being returned complies with OSHA and DOT regulations.
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