AkzoNobel Functional Chemicals
Cylinder Return Form
Customer Name:
Order Numbers:
Product Name:
Cylinder SN:
Lot Number:
Remaining Product:
Please answer the following questions:
1. Please indicate the reason for cylinder shipment
Potential Quality Problem
Return Used Cylinder to Owner (AkzoNobel)
Container/Cylinder Damage
Clean Cylinder for Filling
AkzoNobel Packaging/Product Error
Customer Order Error
Customer Discontinued Use
Other (specify)
2. Who owns the cylinder?
AkzoNobel
Customer Owned
3. Please indicate which process gas was used to flush the lines prior to removing it from the system.
Nitrogen (N2)
Argon (Ar)
Hydrogen (H2)
Other (specify)
4. What is the pressure in the cylinder or is the pressure equal to / higher than / lower than 760 torr?
Measured Pressure:
or
equal to
higher than
lower than 760 torr
5. During the use of the cylinder did oxygen/air enter your tool?
yes
no
6. During the use of the cylinder did a leak of any kind occur?
If yes please explain:
yes
no
7. Fully describe any issues or concerns associated with this cylinder.
8. Please indicate the responsible contact person:
Name:
Signature:
Phone:
Fax:
Date:
Email:
Address:
RMA # (please record here after form is submitted and RMA is issued) :
Please email or fax (hpmo-returns@akzonobel.com or fax: +1 312 544 7188) the completed form to
your AkzoNobel customer service representative and your AkzoNobel sales representative or regional
distributor to receive an RMA (return material authorization) number.