-29-
Vacuum Pump Check Sheet For Repair
（for disassembly, inspection and repair）
※ Please inform the following items completely for safety precautions against our maintenance
staff. Fill in the item below and attached to the repair pump.
Date of issue ： Year Month Date
Customer’s name ：
Person in charge：
ＴＥＬ ： ＦＡＸ：
Representative Distributor ：
Person in charge：
ＴＥＬ ： ＦＡＸ：
Product Name ： Serial No.（ＭＦＧ．Ｎｏ）：
Purchased Date： Year Month
１．
Request item
□
Repair order during the warranty period（No Charge）
□
Evaluation pump disassembly inspection required or inspection for pump required（No
charge）
□
Immediate repairing is required、（Charge）
□
Periodical inspection or over haul（Charge）
□
Repair order is required and estimation is required before start repairing、
２．
Trouble situation
□ Unusual sound □ Pressure degradation □ Irregular action □ Others
３．
Purpose of the usage（Device’s name if necessary）
４．
Evacuated gas (Type of the gas)
（１）Hazardous situations for injury □Yes □No
（２）Type of the gas・Name of the gas
５．
Operational situation
（１）Operational elapsed time： hr □ 24hrs consecutive operation
□ On Off operation
（２）Installation place：
（３）Ambient temperature：
（４）Operational pressure：
６．
Miserenious information. Please describe any information if necessary.
７．
Send to
□Ulvac Kiko,Inc. CS Center. Yokohama Service Dep.
【Address】1-10-4,
Kitashinyokohama, Kohoku-ku, Yokohama City, Kanagawa Prf, Japan
TEL:045-533-0509 FAX:045-533-0512
□Ulvac Kiko,Inc. CS Center. Miyazaki Service Dep.
【Address】291-7,
Chausubaru, Saito City, Miyazaki Prf. Japan
TEL:0983-42-4135 FAX:0983-43-2159
※
Use this paper by recopying for every information. When sending your information without
this check sheet, repairing may not be acceptable.
