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© Servomex Group Limited 2017
AquaXact Issue 1.0
To obtain a RAN, fill out a copy of this form and contact your regional Servomex service
group.
Customer information:
Company name:
Address:
Contact name:
Phone:
Fax:
Equipment information:
Part or model number:
AquaXact 1688
Serial number:
Original purchase date:
PO number:
Reason for return:
(Failure and hookup
description if
applicable)
Process material(s)
and/or environments
(including radiation) to
which the equipment
has been exposed:
Has the equipment
been decontaminated?
Does a letter stating
that the equipment has
been decontaminated
accompany the
equipment?
