Realax APY, Operating Instructions Manual

Page: 38 / 40

CUSTOMER: PHONE:
CONTACT: FAX:
INTENTION: Repair Warranty Return
MATERIAL DELIVERED: Pump only Complete unit Spare part
UNITS:
PUMP TYPE:
PUMP REFERENCE:
SERIAL NUMBER:
OPERATION TIME (Years):
OPERATING HOURS (h/day):
APPLICATION DATA (* Indicate units):
PRODUCT
VISCOSITY *
DENSITY *
FLOW *
DANGEROUS Corrosive Flammable Toxic
SPEED (rev/min) Min. Max.
SUCTION PRESSURE (BAR)
DISCHARGE PRESSURE (BAR)
TEMPERATURE (ºC)
MEDIA AND WARNINGS
Medium /
Concentration
Identifica-
tion Flammable Toxic Corrosive
Harmful /
Irritant Other* Harmless
Process Medium
Medium for process cleaning
Returned part cleanded
with…
*Explosive; Oxidising; Dangerous for the environment, Biological Risk, Radioactive. Please tick if one of the above is
applicable, include MSDS and, if necessary, special handling instructions.
DESCRIPTION OF FAILURE:
PHOTOS AVAILABLE: Yes No
The pump(s) should be emptied and cleaned of any contamination before it is sent. In case of a corrosive, flammable or toxic, product the pumps
must be accompanied by a certificate of decontamination. Make sure the cleaning product you use is compatible with the materials that make
up the pump and do not cause damage. In case of default we reserve the right to charge the costs of cleaning or returning the pump if necessary.
By signing this form you confirm that you have cleaned the pump(s) in accordance with our recommendation.
We hereby certify that the parts have been carefully cleaned.
To the best of our knowledge they are free from any residues in dangerous quantities.
COMPANY/STAMP:
DATE: NAME: SIGNATURE: