First Name *

Last Name *

Company *

Email *

Phone Number *

Address *

State *

Zip *

Country *

Calibration Service Level

Number of Test Points

Regulated Industry? *

Yes

No

Regulating Body

Interval

Input Voltage *

Calibrate Local Display *

Yes

No

Type *

Process Connection *

Application/Medium *

Line Size *

Manufacturer *

Model *

Serial Number

Asset ID

Condition *

Additonal Comments

Flow Incoming Work Order

In compliance with U.S. Federal OSHA Standard 29CFR1910.1200, process information must be reviewed prior to receiving authorization to return material to Standard Calibrations Inc. (SCI). NO PRODUCT EXPOSED TO MERCURY WILL BE ACCEPTED! Exposure to hazardous materials is regulated by Federal, State, and Local laws and regulations. These laws provide SCI’s employees with the “right to know” the hazardous or toxic materials or substances in which they may come in contact with handling returned equipment or products. Consequently, our employees must have access to data regarding the hazardous or toxic materials or substances which the equipment has been exposed to in your process(es). Accordingly, prior to returning your equipment for evaluation, calibration, or repair, please read then sign the certification below and thoroughly comply with the applicable instructions. CLEANING STATEMENT I certify that the returned and/or serviced item(s) has (have) been thoroughly and completely cleaned. If the returned and/or serviced item(s) has (have) been exposed to hazardous or toxic materials or substances, the undersigned attest that the accompanying Safety Data Sheet(s) (SDS) which cover said materials or substances are complete and accompany the returned item(s). Furthermore, I understand that this certificate, or providing an SDS, shall not waive our responsibility to provide a neutralized, decontaminated, and clean product for inspection/evaluation and/or repair by SCI. Cleanliness of a returned and/or serviced item or the acceptability of the SDS shall be at the sole discretion of SCI. I certify that the above referenced item(s) has (have) been properly purged and cleaned, the procedures comply with U.S. Department of Transportation shipping requirements and DOES NOT present a health and/or safety hazard (as defined by OSHA) to our personnel. Any item returned to SCI for inspection and/or service, which does not comply with these instructions, shall be returned to the “shipped from” location, Freight Collect. IMPORTANT: Your item will not be inspected and/or serviced under any conditions unless this document has been signed.

NOTE: In order to provide an accurate calibration, it is necessary to have all components that are considered to be part of the instrument. Please ensure that the following items are included when removing instruments for calibration. Failure to provide may result in additional charges. 1. Sensor (if separate from transmitter) 2. Transmitter (if separate from sensor) 3. Cabling (any interconnection cable from sensor to transmitter, i.e. non-integral/ remote instruments) 4. Manufacturer’s Operation Manual. REMOVE ALL REDUCING ADAPTERS FROM THE FLOW METER PRIOR TO SHIPPING. SCI WILL NOT BE RESPONSIBLE FOR DAMAGE OCCURRING AS A RESULT OF REMOVING REDUCERS, ADAPTERS, OR FITTINGS. SCI WILL NOT REINSTALL REDUCERS, ADAPTERS, OR FITTINGS.

By clicking "Submit," you certify that all information provided is true and accurate to the best of your knowledge. You also acknowledge that you have read and agree to the terms and conditions outlined in the following statement.