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103A - PAGE 9
Service Form:
TBE / Hastings Instruments RMA#
804 Newcombe Avenue (contact factory)
Hampton, VA 23669 U.S.A.
Telephone (804)723-6531 Fax (804)723-3925
Model No. Serial No. P.O. No. Date
Name Phone
Company
Address
City State Zip
Describe problem:
Show a block diagram of your system including unit inlet and outlet pressures:
Calibration range Gas Cable length
Power line voltage Variation
Ambient temperature Gas Temperature
Other
(If special modifications have been made by user, please describe):
Application of product being returned
Has this product been used with a hazardous material? YES NO
If YES, please list types of gas, chemicals (common names, specific chemical), biological materials, or
other potentially harmful materials exposed to the product during its use (attach additional page if
necessary)
PRODUCTS EXPOSED TO RADIOACTIVE MATERIAL CANNOT BE ACCEPTED BY HASTINGS
INSTRUMENTS UNDER ANY CIRCUMSTANCES.
Signature of Hazards Control Officer:
For questions regarding use of the product and materials in contact with it:
Name Phone