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Sensor Decontamination/ Cleaning Statement
Refer to Micro Motion Return Policy for Use in the U.S.A. with Used Micro Motion Equipment
1) Return Material Authorization (RMA) Number:
2) Equipment to be returned Model Number: Serial Number:
3) Reason for return
Process and Decontamination/Cleaning Fluids
4) List each substance to 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
5) Please 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)
6) Describe decontamination/cleaning process. Include MSDS description for substances used in decontamination and cleaning
processes. Attach additional documents if necessary.
Shipping Requirements
Failure to comply with this procedure will result in the shipment being refused
7) Ship only one sensor per box. RMA number must be noted on the shipping package.
8) Include inside the package: one copy of this document and all required Material Safety Data Sheets (MSDS).
9) Attach to the outside of the package: one copy of this document, and all required Material Safety Data Sheets (MSDS).
10) Ship equipment to: Address correspondence to:
Micro Motion Inc. Attn: RMA# _____________
C/O Veolia Environmental Services
Sensor Department
9131 East 96 Avenue
Henderson CO 80640 USA
Micro Motion Inc.
7070 Winchester Circle
Boulder CO 80301 USA
Attn: Repairs
EQUIPMENT HAS BEEN CLEANED AND DECONTAMINATED OF ANY HAZARDOUS SUBSTANCES
AND MEETS DOT AND EPA REGULATIONS.
By:
(Signature) (Print name)
Title: Date
Company:
Phone: Fax