|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|
Return Procedures Certification
Flotec, Inc.7625 West New York Street, Indianapolis, IN 46214, (317) 273-6960
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 _________________________________________
Authorized Signature ___________________________________
***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(