Respiratory Products
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: info@floteco2.com

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Return Procedures Certification


Flotec, Inc.

7625 West New York Street    Indianapolis, IN 46214,     (317) 273-6960




                (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( 7-13-99 )