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:
Summary of Contents for ISI 10
Page 1: ...Operating instructions ISI Series Peristaltic pump ALL THE HOSE PUMP YOU LL EVER NEED ...
Page 38: ...38 Operating instructions Peristaltic Pump ISI Series 11 3 Spare parts exploded ISI 13 Model ...
Page 42: ...42 Operating instructions Peristaltic Pump ISI Series 11 5 Spare parts exploded ISI 16 Model ...
Page 48: ...48 Operating instructions Peristaltic Pump ISI Series 11 8 Spare parts exploded ISI 22 Model ...
Page 53: ...53 13 Declaration of Conformity ...
Page 59: ......
Page 60: ...AHQ IOM EN 0849 1120 www realaxpumps com ALL THE HOSE PUMP YOU LL EVER NEED ...