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DANIEL MEASUREMENT AND CONTROL, INC.
RETURNED MATERIAL AUTHORIZATION
Repair Form for Used Equipment
Including Decontamination/Cleaning Statement
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 Pryophoric 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.