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Trouble Notification Sheet
This sheet is to be filled with information required for the smooth checking and repair of
malfunctions. Please fill in this sheet in as much detail as possible. Also, attach this sheet
when asking for repair.
High Volume Air Sampler HV-CW Trouble Notification Sheet
If the sampler malfunctions, make a copy of this sheet, fill it in and contact your Sibata
distributor where you purchased the product.
Entry Date (y/m/d):
Product Conditions of Use
Serial No.:
Date of Purchase (y/m/d):
Start of Use (y/m/d):
Frequency of Use:
: Every day
: __ days/week
: __ days/month
Number of Hours Used per Day:
Operating Environment Temperature (measured temperature, if possible): ( )
°
C to ( )
°
C
Number of Installed Units: __ units
Application:
Symptoms of Malfunction
Frequency of Occurrence:
: Every time
: Occasionally
: Rarely
: Other
(
)
Start of Malfunction:
: Since purchase
: Within a month
: Within a week
: Other (
)
Symptoms: (Write in as much detail as possible.)
Ex: Backlight does not turn ON even by pressing a
key.
Check Items (Please choose your answer.)
●
Does the LCD display turn ON when the power to the sampler is turned ON?
( Yes
・
No )
●
Has it been used near the sea or a hot spring? ( Yes
・
No )
●
Are there any signs or scratches on the sampler body indicating that it has been
dropped or impacted? ( Yes
・
No )
Work Check Items When Asking for Repair
: Make a copy of the Trouble Notification Sheet, fill it in and send it together with the
sampler.
: If there is the risk that harmful substances have been sucked into the sampler, put this
Trouble Notification Sheet in an envelope, and stick this to the outside of the box. Also,
be sure to clearly indicate the presence of such substances on the Trouble Notification
Sheet.
