Check Sheet for UFW: The Current Situation.
（
For Check up/Repair
）
【
Send to
】
ULVAC Kiko,Inc.
1-10-4,Kita-shinyokohama,Kohoku-ku,
Yokohama,Kanagawa-ken,223-0059,Japan
CS Center. Service Dep.
Phone no:045-533-0509
FAX:045-533-0512
Customer name
A person in charge
Phone no.
Fax no.
Purchase date:
Dealer’s name
Model name
Serial no.(
ＭＦＧ．Ｎｏ
)
1. Your request in detail:
□
Repair request during assured period (Charge free)
□
Request for overhaul of evaluation target or of defective or faulty machine. (Charge free)
□
Immediate repair request (Charged)
□
Request for regular check up (Overhaul) (Charged)
□
Request for estimation for the repair and repair.
２．
The situation of failure/defect
□
Abnormal noise
□
Pressure failure
□
Operation failure
□
The other
３．
Purpose for vacuum pump or pump name.
Vacuum pump model type
：
Purpose
（
Model name
）
：
４．
Type of vacuum sucking gas
（１）
Effect on health/life:
Harmless
Hazardous
（２）
Gas type/description
（
Mandatory to fill in
）
５．
Operation environment of UFW
（１）
Operation hours
：
hr
□
24hr continuous operation
□
operation between intervals
（２）
Installation location
：
（３）
Ambient temperature
：
（４）
Set up pressure
：
Pa
（５）
Oil in the machines
：
６．
Other information
※
Please fill in the form for safety of repair workers and attach this request from to the pump.
I
ssue date:
Approved by
Requested delivery
date:
