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| 7625 West New York Street | |
| Indianapolis, Indiana 46214-4911 USA | |
| Telephone: (317) 273-6960 | |
| Facsimile: (317) 273-6979 | |
| Order Desk Telephone: (800) 401-1723 | |
| Order Desk Facsimile: (800) 515-9254 | |
| E-mail: flotec@floteco2.com | |
|
|
| 7625 West New York Street | |
| Indianapolis, Indiana 46214-4911 USA | |
| Telephone: (317) 273-6960 | |
| Facsimile: (317) 273-6979 | |
| Order Desk Telephone: (800) 401-1723 | |
| Order Desk Facsimile: (800) 515-9254 | |
| E-mail: flotec@floteco2.com | |
|
Return Procedures Certification |
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Flotec, Inc. 7625 West New York Street, Indianapolis, IN 46214, (317) 273-6960
RGA#(s)_____________________ ________________________________________________________, (Company Name) hereby certifies that the regulators and/or flowmeters contained within have been decontaminated as per OSHA/JCAHO regulations on decontamination procedures.
Flotec, Inc. Part Number(s) ______________________________ Serial Number(s) ______________________________________ P.O. Number _________________________________________ Quantity _____________________________________________ Date ________________________________________________ Authorized Signature ___________________________________ Title ________________________________________________
***This form must have an authorized signature and must be posted on the outside of the box with the RGA# visible. This is necessary in order for receiving to know that this product has been decontaminated before opening the package. Any RGA received without certification will be returned to the sender. F-Return Procedures Certs.doc( |