Return Material Authorization Request (RMA)

-Tank Gauging-
Please use one RMA form per unit. *=mandatory fields

Requestor Information
* Issue date Reference # Send the RMA to
Parts.RTG@Emerson.com
*Contact Name *Company name
Seifiddine Jaziri PIRECO
*Email address * Phone number
seifiddine.jaziri@pireco.com.tn 00216 93199037
Customer Information
*Company *Contact name
PIRECO Seifiddine Jaziri
Delivery address *Original reference (PO, Order No, etc)
201798
*System #/RTG Project #

*Name of Plant (Project Name)

SNDP
Product Information
*Type of equipment *Product in Tank *Serial No *Unit ID / Device ID
2240S GASOIL 50 26625 1800000071
*Part Name *Part/ Item No
Transmetteur de Température
*Reason for return *FA report required

Customer Reported Problem Information

*Failure Description Files included
Holding/input registers
Email correspondence
Service report
*Conditions *Symptoms *Date of failure *Time in Service / Operation

Corrective Actions Taken

*RTG/REP service dept consulted? Name of service engineer
Yes No
*Comments and Actions taken

*Parts used to correct the failure... Is the unit working after corrective action?
Yes No

Office Use Only

RMA Number Supplier RMA # Approved by

Rosemount Tank radar AB Visiting address Telephone

Box 13045 Gamlestadsvägen 18B Int. +46 31 3370 000
SE-402 51 GÖTEBORG V.A.T. number Telefax Website
SWEDEN SE556043512401 Int. +46 31 253 022 www.rosemount-tg.com

RTG_RMA_form_141001_b
a division of Emerson Process Management