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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 Radioactive Explosive Pyrophoric Poison Gas
Cyanides Sulfides Corrosive Oxidizer Flammable Poison
Carcinogen Peroxide Reactive-Air Reactive-Water Reactive-Other (list):
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.