Stanford Research Systems RGA100, Operating Manual And Programming Reference

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Stanford Research Systems, 1290 D Reamwood Ave., Sunnyvale, CA 94089, Ph. (408) 744-9040, FX. 744-9049
Declaration of Contamination of Vacuum Equipment
The repair and/or service of vacuum equipment or components can only be carried out if a completed declaration
has been submitted. SRS reserves the right to refuse acceptance of vacuum equipment submitted for repair or
maintenance work where the declaration has been omitted or has not been fully or correctly completed. SRS also
reserves the right to refuse servicing any vacuum equipment which could potentially be harmful to the personnel
carrying out the repair and service of the equipment. Contact SRS to request additional copies of this form or if you
have any questions regarding the contents of this declaration.
Description of equipment
Equipment type/model: ____________________________________________________
Serial No: ______________________________________________________________
Reason for return (circle one): •• Repair •• Maintenance
Please describe: ___________________________________________________________
________________________________________________________________________
________________________________________________________________________
Equipment condition
1.
Has the equipment been used ? (circle one)
•• Yes •• No
2. Describe the operating environment the instrument was exposed to:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
1. Was any of the equipment exposed to potentially harmful substances? (circle one)
•• No
•• Yes.
Please attach list of all known harmful substances including chemical name and symbol, precautions
associated with the substance and first aid measures in the event of accident.
Were any of the harmful substances:
i
Radioactive? •• Yes •• No
i
Toxic? •• Yes •• No
i
Corrosive? •• Yes •• No
i
Explosive? •• Yes •• No
Was equipment decontaminated/cleaned before being shipped to SRS?
•• Yes •• No •• Not Applicable
i
SRS will not service any equipment that might potentially be harmful to its service personnel.
i
SRS will not accept any equipment which has been radioactively, or explosively contaminated without written
evidence that such equipment has been properly decontaminated.
Legally Binding Declaration
I hereby declare that the information supplied on this form is complete and accurate. The dispatch of equipment will
be in accordance with the appropriate regulations covering Packaging, Transportation and Labeling of Dangerous
Substances.
Name (print):
_________________________________________________________
Job Title: _______________________________________________________________
Organization: ____________________________________________________________
Address: ________________________________________________________________
Telephone: ______________________________ Fax: __________________________
Legally binding signature: ____________________________________________________ Date: ______________