Documents are only to be used and distributed completely and unchanged. It is strictly the users’ responsibility to check carefully
the validity of this document with respect to his product.
page 21 of 24
No. 47800-2-02-5
Check sheet for repair
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．O
perational 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. Service Dep.
【 Address 】 1-10-4,Kita-shinyokohama,Kohoku-ku
,
Yokohama,Kanagawa-ken,223-0059,JAPAN
TEL:045-533-0509 FAX:045-533-0512
※U
se this paper by recopying for every information. When sending your information without this
chec
k
sheet, repairing may not be acceptable.
