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DANIEL
TM
MEASUREMENT AND CONTROL, INC.
RETURNED MATERIAL AUTHORIZATION
REPAIR FORM FOR USED EQUIPMENT INCLUDING
DECONTAMINATION/CLEANING STATEMENT
A Return Material Authorization (RMA) number must be obtained prior to returning any
equipment for any reason. Download the RMA form from the Support Services web page by
selecting the link below.
http://www2.emersonprocess.com/EN-US/BRANDS/DANIEL/SUPPORT-SERVICES/Pages/
Support-Services.aspx
1. Return Material Authorization (RMA) Number
2. Equipment to be returned:
Model Number Serial Number
3. Reason for return:
Decontamination/Cleaning Fluids Process
A. List each substance in which the equipment was exposed. Attach additional documents if necessary.
Common
Name
CAS# if
Available
Used for Hazardous
Waste (20 CFR 261)
EPA Waste Code
if used for hazardous waste
[ ] Yes [ ] No
[ ] Yes [ ] No
[ ] Yes [ ] No
[ ] Yes [ ] No
[ ] Yes [ ] No
[ ] Yes [ ] No
B. Circle any hazards and/or process fluid types that apply:
Infectious
Cyanides
Carcinogen
Radioactive
Sulfides
Peroxide
Explosive
Corrosive
Reactive-Air
Pryophoric
Oxidizer
Reactive-Water
Poison Gas
Flammable
Reactive-Other (list):
Poison
Other Hazard Category (list):
C. Describe decontamination/cleaning process. Include MSDS description for substances used in
decontamination and cleaning processes. Attach additional documents if necessary.